Catecholamine concentrations in biopsied gastroduodenal tissue specimens of patients with duodenal ulcer

We measured dopamine and norepinephrine concentrations in the biopsied gastroduodenal mucosa obtained from 12 ulcer-free dyspeptic patients, nine patients with active duodenal ulcer, and eight patients with inactive (or healed) duodenal ulcer using a high-performance liquid chromatography with electrochemical detection method. Biopsy specimens were taken from endoscopically normal-appearing mucosa in the gastric body and antrum as well as in the duodenal bulb. Additional specimens were obtained from the outer edge of the ulcer margin in patients with active duodenal ulcer. The mean (±SD) mucosal dopamine concentrations in the gastric body and duodenum (7.6±2.8 and 6.8±2.6 pg/mg tissue) obtained from patients with inactive duodenal ulcer were significantly (P<0.05) lower than those from dyspeptic patients (13.6±6.9 and 10.9±3.5 pg/mg tissue, respectively). In contrast, no significant differences were observed in the mean norepinephrine concentrations in these gastroduodenal tissues among the three study groups. However, the mean mucosal norepinephrine concentration in the outer edge of duodenal ulcer (86.2±125.6 pg/mg tissue) was significantly (P<0.05 and 0.01) reduced as compared with that in the ulcer-free area of duodenum obtained from patients with inactive duodenal ulcer (257.1±188.2 pg/mg tissue) and from dyspeptic patients (276.8±138.3 pg/mg tissue). The results suggest that an alteration in the catecholaminergic system may be associated with one of the pathogenic factors of duodenal ulcer.This study was supported by a grant-in-aid from the Ministry of Human Health and Welfare, Tokyo.     

Increased parietal cell responsiveness to tetragastrin in patients with recurrent duodenal ulcer

To clarify the contributive factors in the recurrence of duodenal ulcer, the present study was carried out on 65 male patients with active duodenal ulcers and 20 healthy male subjects. After having verified that the ulcer had healed, gastric acid secretory responses to graded doses of tetragastrin from 62.5 to 16,000 ng/kg/hr were investigated using a logarithmic transformation model. Several clinical features were also investigated. The patients were divided into three groups based on the later endoscopic follow-up study for two years. The early-recurrent group included 16 patients with recurrence occurring within three months. The late-recurrent group included 25 with recurrence occurring after three months. The nonrecurrent group included 24 patients without recurrences during the follow-up period. The 20 healthy male subjects were defined as a control group. The results were as follows: (1) Significant differences were not discerned either in basal and peak acid outputs between the three patients groups. (2) The ED₅₀ value for tetragastrin was lower in the early-recurrent group than in the other three groups. (3) The early-recurrent group showed a higher percentage of smokers than the other patient groups. These results suggest that smoking and increased parietal cell responsiveness correlates strongly with duodenal ulcer recurrence.     

Role of dopamine and other stimuli of mucosal bicarbonate secretion in duodenal protection

Duodenal mucosal secretion of bicarbonate is one main mechanism in the protection of this epithelium against luminal acid. The duodenal secretagogue vasoactive intestinal polypeptide, at doses not affecting mucosal blood flow, protects against acid-induced morphological changes. Some sigma receptor ligands, which increase the duodenal alkaline secretion, prevent duodenal but not gastric mucosal ulceration. Dopamine D-1 receptor agonists and the peripherally acting catechol-O-methyl-transferase (COMT) inhibitor nitecapone stimulate the bicarbonate secretion in the rat and a similar increase in secretion has been observed in human volunteers. COMT inhibitors decrease tissue degradation of catecholamines, including dopamine. The D-2 agonist bromocriptine, in contrast, decreases the secretion. These results, indicating that the bicarbonate secretion is stimulated via peripheral dopamine D-1 receptors, are supported by the finding that dopamine D-1 (but not D-2) agonists increase the production of cyclic AMP in isolated duodenal enterocytes. The increase in mucosal alkaline secretion may contribute to the previously observed ulceroprotective actions of dopaminergic compounds.This work was supported by the Swedish Medical Research Council (grant 04X-3515) and the Swedish Society for Medicine (grants 846.0 and 915.0), Stockholm, Sweden.     

Diet and duodenal ulcer

BACKGROUND: Despite the fact that the main cause of duodenal ulcer incidence and recurrence is the Helicobacter pylori bacterium, more than 80% of Helicobacter pylori-infected people never develop an ulcer. Diet may be one of the most important environmental factors contributing to duodenal ulcer. AIMS: To explore the role of diet in causation, treatment and prevention of duodenal ulcer recurrence. METHODS: All research papers published in English from 1966 to October 1999 present in Medline, involving human subjects, and having duodenal ulcer as outcome, entered the review. RESULTS AND CONCLUSIONS: Soluble fibre from fruit and vegetables seem to be protective against duodenal ulcer and refined sugars a risk factor. The role of fibre in the treatment and prevention of recurrence of duodenal ulcer is uncertain, as is that of essential fatty acids. However, none of the epidemiological studies on the relationship between diet and duodenal ulcer disease controlled for Helicobacter pylori.     

胃、十二指肠溃疡患者内皮素Ⅰ水平初步探讨

本文研究３２例胃、十二指肠溃疡患者血浆、胃液及胃、十二指肠溃疡缘与正常胃粘膜组织中内皮素Ⅰ的水平，并以１９例健康人作对照。结果表明：胃溃疡患者血浆内皮素Ⅰ水平为４．４８±０．７８ｐｇ／ｍｌ，明显高于健康对照组血浆水平２．５６±０．１７ｐｇ／ｍｌ，Ｐ＜０．０５。胃溃疡缘组织中内皮素Ⅰ含量为４１．６３±４．３６ｐｇ／ｍｇ，明显高于自身正常胃粘膜２１．８４±１．７３ｐｇ／ｍｇ和健康对照组内皮素Ⅰ含量２１．７８±１．６８ｐｇ／ｍｇ，Ｐ值均＜０．００１。提示内皮素Ⅰ可能作为局部因素参与胃溃疡的形成，并说明胃溃疡患者有血管收缩和舒张因子的代谢不平衡。而十二指肠溃疡患者血浆、胃液、组织中内皮素Ⅰ水平与健康对照组无明显差异，提示内皮素Ⅰ在十二指肠溃疡发病中并不起重要作用。     

Somatostatin in gastric juice in normal subjects and patients with duodenal ulcer

Somatostatin in gastric juice was determined in normal subjects and patients with duodenal ulcer. Gel exclusion chromatography of gastric juice revealed that the main immunoreactivity existed at the position of somatostatin-14. A large amount of somatostatin was present in gastric juice, and the quantity increased following tetragastrin stimulation. Furthermore, there was a good inverse correlation between somatostatin concentration and acidity of gastric juice; however, there was no difference between normal subjects and patients with duodenal ulcer in the amount of somatostatin released into gastric juice.     

The personality pattern of duodenal ulcer patients in relation to spontaneous ulcer healing and relapse

One hundred consecutive out-patients with duodenal ulceration from a hospital and a gastroenterological clinic were tested with the Minnesota Multiphasic Personality Inventory (MMPI). This was carried out in order to investigate whether neuroticism or other personality disorders were characteristics of duodenal ulcer patients, and whether the presence of such possible personality disorders might influence the prognosis of the disease. Neuroticism occurred in 53% of the patients, but only in 5% of controls (P less than 0.0001). Overall, personality disorders were present in 69% of the patients compared with 30% of the controls (P less than 0.0001). Neuroticism was connected with a high frequency of relapse (P less than 0.05) whereas failure of spontaneous ulcer healing had no certain relation to personality disorders. Patients with non-neurotic personality disorders had more frequently suffered stressful life events before entrance to the study (P less than 0.05) and, like the neurotic patients, they had lower ego-strength to cope with such events (P less than 0.05). The results indicate that personality assessments make it possible to distinguish between subgroups of duodenal ulcer patients with different course of the disease.     

Giant duodenal ulcer

Patients with giant duodenal ulcer (>2 cm) have more ulcer complications (ie, bleeding) than patients with duodenal ulcer in the standard range (0.5–1.5 cm). To evaluate possible differences between patients with giant duodenal ulcer and those with duodenal ulcer in the standard range, we determined basal acid outputs by nasogastric suction, percentage of patients with daily nonsteroidal antiinflammatory drug (NSAID) use, and percentage of ulcer complications in 184 patients with endoscopically documented active duodenal ulcer. Seventeen patients had giant duodenal ulcer, and 167 patients had duodenal ulcer in the standard range. The mean basal acid outputs for the 17 patients with giant duodenal ulcer was 7.9 meq/hr (range 0.0–27.8 meq/hr) and for the 167 patients with duodenal ulcer in the standard range was 9.0 meq/hr (range 0.0–49.1 meq/hr), which were not significantly different. There was a significant difference in the percentages of ulcer complications between the 17 patients with giant duodenal ulcer and the 167 patients with duodenal ulcer in the standard range: 65% compared to 25% (P=0.001), and in the percentages of patients with regular daily NSAID use, during the one month preceding the upper gastrointestinal endoscopy: 53% compared to 8% (P=0.00001). However, a significant association between NSAID use and duodenal ulcer complication was not apparent. These results suggest that the development of giant duodenal ulcer and the significant increase in complications associated with giant duodenal ulcer are not attributable to increased basal acid output, however, they may be attributable to increased NSAID use.     

Prevalence of Helicobacter pylori infection in duodenal ulcer and gastro‐duodenal ulcer diseases in Taiwan

Background and Aim: The prevalence of Helicobacter pylori‐negative duodenal ulcer (DU) is increasing in Western countries but is rare in Japan. We aimed to examine the prevalence of H. pylori infection and the characteristics in DU and gastro‐duodenal ulcer (GDU) diseases in Taiwan. Study: All patients with an endoscopic diagnosis of DU or GDU from September 2003 to May 2004 at Taipei Veterans General Hospital were included. Rapid urease test was done for all patients, while urea breath test was carried out on those with negative rapid urease tests. A patient was considered infected if either test was positive. Results: The prevalence of H. pylori was 88.7% (555/626) in DU and 90.5% (95/105) in GDU patients. There was no difference in sex and prevalence of H. pylori between the two groups but age was higher in the GDU patients (60.1 ± 15.5 vs. 55.4 ± 15.5, P = 0.005). Of H. pylori‐negative DU patients, 28.2% (20/71) reported using non‐steroidal anti‐inflammatory drugs (NSAIDs)/aspirin, which were used by all 10 H. pylori‐negative GDU patients (100%) (P < 0.001). There was no difference in sex and age between H. pylori‐positive and negative DU patients. The prevalence rate of H. pylori in DU was not statistically different among outpatients, inpatients, and physical check‐up subjects (86.8% vs. 93.3% vs. 90.7%, P = 0.163). Conclusion: The prevalence of H. pylori infection in DU appears to be decreasing in Taiwan. Thus, eradication therapy without confirming the presence of H. pylori in DU patients cannot be recommended. NSAIDs/aspirin is the major risk factor for H. pylori‐negative DU patients, especially those with co‐morbid gastric ulcer.     

消化性溃疡患者粘膜生长抑素和精氨酸加压素分布和意义

回的:为了研究消化性溃疡患者粘膜生长抑素(SS)和精氨酸加压素(AVP)的分布及其在溃疡发病中的作用。方法:应用放射免疫分析法对39例消化性溃疡患者胃、十二指肠粘膜SS和AVP含量进行了测定,并以20例慢性浅表性胃炎(CSG)作对照。结果:十二指肠溃疡(DU)胃(体、窦分别为177.1±115.6,330.9±92.6Pg/mg)十二指肠粘膜SS含量(153.5±106.5Pg/mg)显著低于CSG(分别为288.8±181.1,559.9±381.5和252.7±152.9Pg/mg,P<0.05),而DU球部粘膜AVP含量(52.3±29.7Pg/mg)显著高于CSG(37.7±19.2Pg/mg)。GU与CSG组比较均无显著性。结论:①胃、十二指肠存在AVP样物质;②DU发生与粘膜SS、AVP分泌失调有关。     

Regression of duodenal gastric metaplasia in Helicobacter pylori positive patients with duodenal ulcer disease

Background. It is unclear whether the extent of duodenal gastric metaplasia is due to Helicobacter pylori and/or acid.Aims. To investigate the role of Helicobacter pylori eradication in the regression of duodenal gastric metaplasia in patients with duodenal ulcer maintained in acid suppression conditions.Methods. Duodenal (anterior, superior, inferior walls of first part of duodenum) and gastric antrum biopsies were obtained from 44 Helicobacter pylori positive duodenal ulcer patients. Helicobacter pylori infection was diagnosed by rapid urease test, histology and ¹³C-Urea Breath Test. Patients were treated with 20 mg omeprazole tid associated with 250 mg clarithromycin and 500 mg amoxycillin four times daily for 10 days and maintained with 20 mg omeprazole daily for 18 weeks. Control endoscopies were performed at 6 and 18 weeks after beginning treatment.Results. Duodenal gastric metaplasia regression was observed in all ( ) patients in whom Helicobacter pylori was eradicated, but in only 3 out of 6 patients in whom eradication was not achieved (p<0.001).Conclusions. The present results suggest that Helicobacter pylori eradication associated with prolonged acid suppression may represent a good therapeutic strategy to achieve duodenal gastric metaplasia regression and highlight the combined role of acid and Helicobacter pylori in the pathogenesis of duodenal gastric metaplasia.     

Hypersomatostatinaemia in duodenal ulcer

Abstract A sensitive and specific radioimmunoassay of serum somatostatin has been developed that overcomes the problems encountered in earlier assays of peptide disintegration and the need for prior plasma extraction, which is known to result in artifactual loss of somatostatin. In 37 normal controls, a significant positive correlation between fasting serum gastrin and somatostatin concentrations, and a significant negative correlation between pentagastrin-stimulated maximal acid output and fasting serum somatostatin levels were observed. In the majority of 134 patients with active duodenal ulcer in whom the fasting serum somatostatin levels were normal, these relationships were absent. In the remaining 25% in whom the fasting serum somatostatin levels were abnormally raised, these relationships were retained. Following a mixed meal, circulating somatostatin levels remained unchanged in controls and patients as a group. These results suggest that: (i) in the normal state, fasting levels of circulating gastrin and somatostatin are closely related, and that acid secretion may paradoxically exert an inhibitory effect on fasting somatostatin levels; (ii) hypersomatostatinaemia identifies a subgroup of patients with duodenal ulcer in whom these relationships are retained; and (iii) somatostatin may not have a significant hormonal role in the postprandial state in man.     

21310例十二指肠溃疡流行病学分析

目的探讨十二指肠溃疡的流行病学特点。方法对南宁市17家医院1992—1997年经胃镜检查诊断为十二指肠溃疡的21310例患者资料进行回顾性分析。结果①从行胃镜检查的104121例患者中检出十二指肠溃疡21310例,检出率为20．47％,占检出的消化性溃疡87．87％。②十二指肠溃疡中,男16002例、女5308例,男性发病人数多于女性（P〈0．01）。③中青年是十二指肠溃疡的高发年龄,30～39岁年龄段是检出的高峰。④十二指肠球部溃疡的易发部位依次为前壁（47．16％,11662处）、大弯（24．90％,6159处）、小弯（16．67％,4123处）、后壁（11．27％,2787处）。霜斑样溃疡在十二指肠球后发生率较高。⑤十二指肠溃疡发病与季节有一定关系,检出率最高的是冬春季。结论十二指肠溃疡患者男性多于女性;中青年为十二指肠溃疡高发人群,球部溃疡以前壁最多见;霜斑样溃疡在十二指肠球后较常见;十二指肠溃疡冬春季检出率高于夏秋季。     

Seasonal changes in symptomatic duodenal ulcer activity in Taiwan: a comparison between subjects with and without haemorrhage

Abstract. Tsai C-J, Lin C-Y (Chi Mei Foundation Hospital, Tainan, Taiwan). Seasonal changes in symptomatic duodenal ulcer activity in Taiwan: a comparison between subjects with and without haemorrhage. J Intern Med 1998; 244 : 405–10.

Objectives

To examine if climatic changes may influence the presentation of pain and haemorrhage in patients with duodenal ulcers.

Design

Cross-sectional study.

Setting

Tertiary referral centre.

Subjects

A total of 10 331 symptomatic duodenal ulcer diseases were diagnosed from 1989 to 1996. The patients who had any extrinsic factors that might influence the exacerbation of duodenal ulcer were not included. Patients were divided into those whose ulcer bled once or repeatedly as distinct from those whose ulcers caused pain without haemorrhagic complications. Patients with acute cholangitis diagnosed in the same period were studied as controls.

Results

During the 7-year period, 10 331 symptomatic duodenal ulcer diseases were diagnosed. Amongst these, 5328 showed active duodenal ulcer without haemorrhage, 2088 showed acute duodenal ulcer with stigmata of recent haemorrhage, and 2915 showed a deformed bulb. The incidence of total duodenal ulcers showed significant monthly variation and was found to be more common from November to March (P < 0.001). The monthly incidence of total episodes of upper gastrointestinal tract bleeding peaked from November to March (P < 0.001) with significant variation. The monthly incidence of bleeding episodes from duodenal ulcer only was the same (P < 0.001). In patients whose duodenal ulcers repeatedly caused pain without haemorrhage, there were significant monthly fluctuations, with peak months from December to March (P < 0.001). In the control diagnosis, there were no significant calendar variations (P = 0.85).

Conclusions

Our study has shown that both groups of patients demonstrated similar monthly fluctuations. The incidence is significantly higher during the cold seasons. These data suggest that climatic changes may influence the presentation of pain and haemorrhage in duodenal ulcer patients.

     

抗菌和抑酸治疗十二指肠溃疡的差别

目的 研究抗菌疗法、奥美拉唑及雷尼替丁对十二指肠溃疡治疗作用的差别。 方法 尿素酶试验、幽门螺杆菌的组织学检测、胃窦及溃疡周围组织的炎症变化的光镜和电镜观察。 结果 抗菌疗法组对幽门螺杆菌的清除和溃疡组织的恢复最优,奥美拉唑组次之,雷尼替丁组上述变化不明显。(治疗前后尿素酶试验阳性率分别为:100％→9％,88％→54％,89％→89％;溃疡周边炎症积分分别为:2.9±0.1→1.8±0.2,2.6±0.2→2.6±0.3,2.7±0.3→2.6±0.2)。 结论 抗菌治疗由于可清除幽门螺杆菌,促进溃疡愈合的质量最好,可能是其复发率低的因素。奥美拉唑虽不能清除幽门螺杆菌,却能抑制该菌的活性。     

Prevalence of duodenal ulcer in cirrhotic males referred for liver transplantation

The prevalence of symptomatic duodenal ulcer (DU) assessed primarily in alcoholic males with cirrhosis is estimated to be approximately fivefold increased compared to the normal population. Little information is available, however, as to the prevalence of DU in nonbleeding, nonalcoholic subjects with cirrhosis. In order to estimate the prevalence of DU in males with various types of cirrhosis and its relation to the degree of portal hypertension, 216 male cirrhotic patients (165 with parenchymal liver disease and 51 with cholestatic liver disease) being evaluated for liver transplantation at the University of Pittsburgh between January 1985 and June 1987 underwent pan-upper gastrointestinal endoscopy. The prevalence of DU in each group was 7.8%. However, among the various subgroups it was as follows: chronic active hepatitis due to HBV: 9.4%, alcoholic: 12.2%, cryptogenic: 3.5%, autoimmune chronic active hepatitis: 6.6%, primary sclerosing cholangitis (PSC): 9.5%. The reference data for this study consist of data reported in the literature obtained in 355 healthy asymptomatic male volunteers. The prevalence of DU in this group is significantly less than in the study group (2.2% vs 7.8%; P<0.005). While the estimated risk for a DU is increased 3.71-fold (95% CI: 8.74, 1.57; P<0.005) in cirrhotic males in general as compared to normal males, only the subgroups with CAH due to HBV, alcoholism, and PSC were found to have an increased estimated risk of DU (all at least P<0.01). No association between the prevalence of DU and degree of portal hypertension could be demonstrated in either group.This work was supported in part by grants from NIDDK (DK32556) and from NIAAA (A06601).     

A comparison of omeprazole and ranitidine for duodenal ulcer in South African patients

The study was a multicenter double-blind parallel-group comparison of omeprazole, a proton-pump inhibitor, with the H₂-receptor antagonist, ranitidine, in 206 patients with duodenal ulcer. There were 145 men and 62 women of mixed racial origin with an average age of 40 years (range 19–76); 63 of them were white, 7 black, 135 coloured and 1 Asian. Each drug was given for four weeks and ulcer healing rate, symptom relief, and adverse events were recorded and compared between treatment groups. Patients received either 20 mg omeprazole once daily in the morning (N=104) or ranitidine 300 mg once daily at night (N =106). Healing rates were significantly higher in the omeprazole group than in the ranitidine group at both two weeks (80% vs 52%,P<0.001) and four weeks (95% vs 85%,P<0.05), using the per protocol approach, and these results were confirmed using the intention to treat approach. Omeprazole-treated patients reported significantly less daytime epigastric pain (P=0.02) and heartburn (P=0.04) after two weeks than ranitidine-treated patients. By four weeks, there were no significant differences in symptom reporting between groups. Both treatments were well tolerated, and there were no serious adverse events.The study materials and funding were provided by Astra Pharmaceuticals International     

Effect of smoking on gastric acid secretion in patients with duodenal ulcer

The effect of smoking on gastric secretion was studied in 15 consecutive patients with duodenal ulcer--six normosecretors (basal acid output less than or equal to 3 mEq/h), and nine hypersecretors (basal acid output greater than 3 mEq/h). The volume, acid output, acid concentration, and pH of the gastric juice measured before, during and after 1 h of smoking did not show any significant difference in these patients taken as a single group, or when the normosecretors and hypersecretors were analysed as separate groups (P greater than 0.05 for each parameter in each group). The higher acid output before and during smoking in hypersecretors than in normosecretors was due to the higher acid concentration in the gastric juice (P less than 0.01). Study of the pH curves of the gastric juice after acute smoking showed that hypersecretors had a lower pH for a longer duration compared with normosecretors. This could make the hypersecretors with a history of chronic smoking more prone to developing duodenal ulcer.