血清胃蛋白酶原检测诊断消化性溃疡的临床价值

目的探讨血清胃蛋白酶原（PG）检测诊断消化性溃疡（PU）的临床价值。方法采用时间分辨荧光免疫分析法检测98例PU患者和52例健康者的血清PGⅠ、PGⅡ和PGⅠ/PGⅡ,并进行比较。结果与健康者比较,PU患者血清PGⅠ、PGⅡ升高（P〈0.01）,PGⅠ/PGⅡ无明显变化（P〉0.05）。以受试者工作特征曲线分析PGⅠ、PGⅡ对DU的诊断价值,曲线下面积分别为0.79、0.72;PGⅠ205 ng/ml为其最佳诊断阈值,其灵敏度54.1%,特异度94.2%;PGⅡ17.5 ng/ml为其最佳诊断阈值,其灵敏度37.8%,特异度92.3%。结论血清PGⅠ、PGⅡ升高提示患PU的风险增加,PG检测在PU筛查及诊断中均有临床意义,PGⅠ可作为经济实用的PU筛查指标。     

Observations on peptic ulcer in Shan Dong, China

The study consisted of 10 994 inpatients with peptic ulcer in Shan Dong province. The ratio of duodenal to gastric ulcer was 1.59 : 1. The ratio of males to females was 6.8 : 1 for duodenal ulcer and 4.6 : 1 for gastric ulcer. The highest incidence was in adolescence and young adults and the presentation occurred more commonly in winter. A study of blood groups revealed that there was no relationship between blood group and duodenal or gastric ulcer. The majority (71.9%) of patients with peptic ulcer had complications of upper gastrointestinal bleeding, perforation or gastric outlet obstruction. Bleeding and obstruction were equally common in gastric and duodenal ulcer, but perforation was more common in gastric ulcer.     

Perforated peptic ulcer in Hong Kong and New South Wales

Direct comparisons of ulcer perforation rates and trends between countries have not been made in the past. Data on hospital admissions for perforated peptic ulcer during 1 January 1979 to 31 December 1985 were collected in Hong Kong (5868 perforations) and New South Wales, Australia (1669 perforations). Age and sex specific rates per 100,000 population were calculated. In Hong Kong, annual duodenal ulcer and gastric ulcer perforation rates were 13-16 and under two per 100,000 population respectively. In New South Wales, the corresponding rates were between three and four and under two per 100,000 population, respectively. The male:female ratios for duodenal ulcer perforation were consistently about 5:1 in Hong Kong and 2:1 in New South Wales, and for gastric ulcer perforation about 2:1 and 1:1, respectively. The incidence of perforation increased with age, and there was a statistically significant rise, over time, in duodenal but not gastric ulcer perforation rates in persons aged over 60 years in New South Wales; similar trends were seen in Hong Kong. Thus duodenal ulcer perforation occurs five times more commonly in Hong Kong than in New South Wales and this is largely accountable for by the higher rates of duodenal ulcer perforation in Chinese than in Australian males. Such geographical differences can best be explained by the occurrence of multiple aetiological mechanisms in ulcer perforation. Furthermore, there appears to be an increased susceptibility and an appreciable rising trend for duodenal ulcer perforation to occur in the elderly.     

Risk factors of peptic ulcer disease: Different impact of Helicobacter pylori in Dutch and Japanese populations?

Helicobacter pylori, non-steroidal anti-inflammatory drugs, family history, blood group O, hyperpepsinogenaemia A, alcohol and smoking have been reported to be risk factors for peptic ulcer disease. The strength of causal risk factors may differ in different populations. In 215 Japanese and 493 Dutch employees of similar age, gender and type of occupation, a structured history was obtained using a questionnaire and fasting serum samples were analysed for IgG antibodies to H. pylori and pepsinogen A all in the same laboratory. A past ulcer history was verified through case notes. We found that H. pylori seropositivity, a high serum pepsinogen A and a family history of ulcer disease were significant and independent risk factors for peptic ulcer disease. For H. pylori seropositivity there was a 20-fold increased risk among the Dutch and an eight-fold increased risk among the Japanese. The seroprevalence of H. pylori was 90% in 20 Dutch subjects with a verified ulcer history and 95% in 41 Japanese ulcer subjects; it was 29% in Dutch non-ulcer subjects and 70% in Japanese non-ulcer subjects. The cumulative difference in risk to develop peptic ulcer disease at the age of 48 years between H. pylor-infected and -uninfected subjects was 24.5–3.0 = 21.5% for the Japanese and 11.8–0.5 = 11.3% for the Dutch. Duodenal ulcer disease was associated with a high coffee consumption only among the Japanese population, where this habit was much less prevalent than among the Dutch. In conclusion, the characterization of peptic ulcer risk factors as weak or strong has no universal basis: the present study shows that from a diagnostic point of view H. pylori appears to be a weaker risk factor for peptic ulcer disease in a society with a higher seroprevalence. However, from an aetiological point of view, H. pylori has an even greater impact on ulcer morbidity in the Japanese than in the Dutch population.     

Antibody to herpes simplex virus type 1 in peptic ulcer patients

It has been postulated that herpes simplex virus type 1 may be a causative factor of duodenal ulcer. Serum antibody titres to herpes simplex virus type 1 in duodenal and gastric ulcer patients were compared with race-, sex- and age-matched controls. No differences in antibody titres could be demonstrated between duodenal ulcer and gastric ulcer patients and their respective controls, between gastric ulcer and duodenal ulcer patients or between acute and convalescent sera in either gastric or duodenal ulcer. Although Chinese are more susceptible to ulcer disease than Malays and Indians, antibody titres were comparable between subjects of different races. The results of this study do not support a causal role for herpes simplex virus in peptic ulcer disease.     

Helicobacter pylori and gastric acid output in peptic ulcer disease

Helicobacter pylori is associated with peptic ulcer, and a causal relationship has been postulated. We investigated the association betweenHelicobacter pylori and gastric acid output. Two hundred forty-one patients were studied: 173 with duodenal ulcer, 51 with gastric ulcer (41 corpus, 10 prepyloric), and 17 with combined gastric and duodenal ulcer. In 194 patients (80%),Helicobacter pylori could be demonstrated histologically from gastric antral biopsies. The presence or absence ofHelicobacter pylori was not influenced by age, sex, or use of tobacco or analgesics. Patients with duodenal ulcer or combined gastric and duodenal ulcer had similar gastric acid outputs irrespective of the presence or absence ofHelicobacter pylori. However, gastric ulcer patients withHelicobacter had higher basal and maximal acid outputs when compared to patients withoutHelicobacter (mean basal output: 4.1 mmol/hr vs 2.4,P<0.05; mean maximal output 19.5 mmol/hr vs 14.4,P<0.05). AlthoughHelicobacter pylori is associated with both gastric ulcer and duodenal ulcer, its significance may be different in the two diseases.     

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。     

Association between clinical manifestations of complicated and uncomplicated peptic ulcer and visceral sensory dysfunction

Background and Aims: Peptic ulcer disease (PUD) usually manifests as either dyspepsia or less commonly with complications such as bleeding. Patients with bleeding ulcers are often asymptomatic until the bleeding occurs. A lack of dyspeptic symptoms might be explained by impaired visceral sensory function. The aim of this study was to assess symptom profiles and compare visceral sensory thresholds in patients with bleeding peptic ulcer (BPU) and uncomplicated PUD. Methods: A total of 30 patients with BPU, 25 with uncomplicated PUD and 32 healthy controls (HC) without dyspeptic symptoms were recruited. In ulcer patients after at least 8 weeks of ulcer treatment and an 8‐hr fast, visceral sensitivity was tested using a standardized nutrient challenge with an enteral feeding solution. Five key symptoms (fullness, abdominal pain, retrosternal/abdominal burning, nausea, and regurgitation) were assessed using visual analog scales (0–100). Results: Twenty‐five of the 30 (83%, 95% confidence interval 65–94%) patients with BPU had no dyspeptic symptoms compared with none of the 25 uncomplicated PUD patients. Patients with BPU and HC had significantly lower symptom responses (BPU 127.6 ± 24.6, HC 89.8 ± 13.9) to the nutrient challenge than uncomplicated PUD patients (338.4 ± 56.2, P < 0.0001). Patients with dyspeptic symptoms (30/55) had significantly higher symptom responses (327.3 ± 47.8) than the 25/55 patients without symptoms (98.9 ± 23.4, P < 0.0001). Conclusion: Most patients with BPU present without dyspeptic symptoms. Even after healing of the ulcer, patients with uncomplicated PUD have a significantly augmented symptom response to a standardized nutrient challenge compared to patients with complicated ulcers and HC. Differences in the processing of upper gastrointestinal visceral afferents may play a major role in the clinical presentation (complicated vs uncomplicated) of PUD.     

Plasma Histamine and Serum Pepsinogen I Concentrations in Chronic Myelogenous Leukaemia

ABSTRACT A male patient with multiple gastroduodenal ulcers and gastric hypersecretion due to hyperhistaminaemia associated with extreme basophilia occurring in chronic myelogenous leukaemia (CML) is described. In addition, plasma histamine levels and serum pepsinogen I concentrations, reflecting gastric acid secretion, were studied in 18 CML patients. As compared to controls, plasma histamine levels were clearly increased in CML patients and correlated well with the basophil count. Serum pepsinogen I concentrations were normal in 14 out of 17 cases and did not correlate with plasma histamine levels. This absence of a direct relation between plasma histamine concentrations and serum pepsinogen I levels suggests that a high concentration of circulating histamine does not inevitably lead to increased gastric acid secretion. This offers one explanation of the fact that, in spite of the frequent occurrence of basophilia and hyperhistaminaemia in CML, ulcerogenic diathesis is quite rare in this disease and complicates only cases with extreme basophilia.     

Thickness of Brunner’s glands and its clinical significance in peptic ulcer diseases

The thickness of Brunner’s glands was measured using an ocular micrometer in 297 cases of surgically resected peptic ulcer and in 120 autopsy cases (control group). The mean maximum thickness of Brunner’s glands in the control group was 1.55±0.37mm (mean±SD) and no difference in thickness was noted for each decade of age. The mean maximum thickness of Brunner’s glands in patients with gastric ulcer, duodenal ulcer and gastroduodenal ulcer was 2.34±1.06, 3.18±1.07 and 3.24±1.05mm, respectively. When an ulcer is within the duodenum, Brunner’s glands near the ulcer were thicker than those contralateral to it. In patients with gastric ulcer, Brunner’s glands were the thickest in the pyloric ulcer group and negative correlation was noted between the thickness of Brunner’s glands and the distance to the ulcer from the pyloric ring. Since gastric acidity is supposed to be lower when an ulcer is located more proximally, these results suggest that Brunner’s glands become hyperplastic not only with the presence of an ulcer in the duodenum but also by acid hypersecretion of the stomach.     

Efficacy of pantoprazole in the prevention of peptic ulcers, induced by non-steroidal anti-inflammatory drugs: a prospective, placebo-controlled, double-blind, parallel-group study

AIM: To evaluate the efficacy of pantoprazole in preventing gastrointestinal lesions in patients with rheumatic diseases receiving continuous, long-term treatment with non-steroidal anti-inflammatory drugs. MATERIAL: This was a prospective, randomised, double-blind, unbalanced, placebo-controlled, parallel group study. Outpatients (n= 104, age range 22-80 years, mean age 59.5) with rheumatoid arthritis or osteoarthritis, requiring chronic intake of NSAIDs (at least 8 weeks prior to the start of the study), were randomised and enrolled to receive either 40 mg pantoprazole (n=70) or placebo (n=34) once daily, for 12 weeks. Patients had endoscopically confirmed gastric and duodenal lesions grade 0, 1 or 2 (Lanza classification grade 0: normal to hyperaemic mucosa; grade 1: 1 to 3 erosions, submucosal haemorrhage or petechiae, grade 2: 4 to 10 erosions, submucosal haemorrhages or petechiae). Clinical and endoscopic evaluations were performed at baseline, after 4, and 12 weeks. The primary end-point of the study was the incidence of gastric or duodenal ulcers after 4 and 12 weeks of treatment. RESULTS: Patients (n=95) were evaluated: 65 in the pantoprazole group and 30 in the placebo group. When considering all patients (those with Lanza score grade 0, 1, 2 at baseline), the overall proportion of patients in remission was 82% and 77% after 4 weeks, and 72% and 59% after 12 weeks in pantoprazole and placebo groups, respectively (cumulative survival analysis according to Kaplan-Meier). The difference between the treatment groups was even more marked when only those patients with normal mucosa at baseline (grade 0) were considered. After 12 weeks, the proportion of patients in remission was 82% (95% confidence limits 70% - 94% in the pantoprazole and 55% (95% confidence limits 33% - 77%) in the placebo treatment group, p=O.036. Adverse events were reported in 4% and 6% of patients in pantoprazole and placebo treatment groups, respectively CONCLUSIONS: Pantoprazole 40 mg once daily was well tolerated and is more effective than placebo in the prevention of peptic ulcers in patients with rheumatic diseases who require continuous, long-term, treatment with NSAIDs.     

Helicobacter pylori eradication improves gastric histology and decreases serum gastrin, pepsinogen I and pepsinogen II levels in patients with duodenal ulcer

Background and Aim: The aim of this study was to assess the gastric histopathology and serum gastrin‐17 and pepsinogens profiles in patients with duodenal ulcer before and after Helicobacter pylori eradication in a population with a very high prevalence of H. pylori. At the same time we assessed the role of H. pylori density on these variables. Methods: Eighty Caucasian patients with H. pylori–associated duodenal ulcer before treatment and 1 year after randomized eradication were studied. Among patients with unsuccessful eradication two groups were distinguished according to the data obtained after treatment: the group with negative rapid urease test and decreased bacterial density according to morphological score (partial elimination group); the group with positive rapid urease test and high bacterial density (failed eradication group). Results: One year after successful eradication, serum levels of gastrin‐17, pepsinogen I and pepsinogen II decreased. Similar changes of serum pepsinogen I and pepsinogen II levels were observed in patients with partial elimination of H. pylori infection. In the group with successful eradication, inflammation, activity, atrophy and number of lymphoid follicles in the antral mucosa fell. In the group with partial elimination, antral mucosa activity and H. pylori score reduced. Other morphological changes were statistically non‐significant. Conclusion: Patients with duodenal ulcer after successful eradication have improvement of morphological and functional characteristics of gastric mucosa.     

Clinical significance of gastric juice viscosity in peptic ulcer patients

We developed a simple method of determining gastric juice viscosity using a cone plate viscometer and tested its clinical application in the staging of peptic ulcers. We found a significant positive correlation between viscosity and macromolecular glycoprotein concentration of gastric juice P<0.001).Gastric juice viscosity in active and healing gastric ulcer patients was significantly lower than that in the scarring stage or hospital control patients P<0.05 and P<0.01, respectively). In duodenal ulcer patients, a significant difference was found between the active and healing stages and hospital controls P<0.01). However, the difference between the active and healing stages and the scarring stage was not significant. Gastric juice viscosity is a simple, reliable, clinically useful measure.     

Time-trends in the epidemiology of peptic ulcer bleeding

Objective. Despite the introduction of effective medical treatment of peptic ulcer disease, bleeding is still a frequent complication. The aim of this study was to investigate whether the incidence and the risk profile of peptic ulcer haemorrhage have changed within a 10-year period. Material and methods. In a prospective epidemiological and observational study the incidence and risk profile of peptic ulcer haemorrhage in Düsseldorf, Germany were compared between two time periods (period A: 1.3.89–28.2.90 and period B: 1.4.99–31.3.2000), involving nine hospitals with both surgical and medical departments. Patients with proven peptic ulcer haemorrhage at endoscopy or operation were included in the study; those with bleeding under defined severe stress conditions were excluded. Results. No differences in bleeding ulcer incidence were observed between periods A and B (51.4 per 100,000 person-years versus 48.7), or for duodenal ulcer (24.9 versus 25.7) or for gastric ulcer bleeding (26.5 versus 23.0). A marked increase in incidence rates was observed with increasing age. In period B, patients with bleeding ulcers were older (56% versus 41% 70 years or older), were usually taking non-steroidal anti-inflammatory drugs (NSAIDs) (45% versus 27%) and were less likely to have a history of ulcer (25% versus 59%) compared with patients in period A. Conclusions. The persisting high incidence of peptic ulcer disease is a superimposing of two trends: a higher incidence in the growing population of elderly patient with a higher intake of NSAIDs and a lower incidence among younger patients due to a decrease in incidence and improved medical treatment.     

Serum pepsinogen I levels of gastric ulcer patients are determined by the location of the ulcer crater

To examine the relation between gastric ulcer (GU) location and serum pepsinogen I (PGI) level, we measured this marker in 284 endoscopically proved GU patients. Their ulcer locations were further divided according to Johnson’s criteria modified to the corpus (type la), gastric angle (type lb), combined with duodenal ulcer (type 2) and prepyloric area (type 3). The numbers of each subset were 96, 81, 58 and 49, respectively. Mean serum PGI level (99.6 ± 44.8 ng/ml) of all GU patients showed no difference from that of their sex and age matched controls. Mean serum PGI levels in both type la and lb patients, did not differ from each other but were significantly lower than in controls, in contrast to those in type 2 and 3 patients which were significantly higher than in controls and comparable to the PGI levels of patients with duodenal ulcer. Smoking did not affect mean serum PGI levels in all subsets except the smoking type 2 patients who manifested a significantly higher mean PGI level. Helicobacter pylori infection did not show different serum PGI levels in any subset. In conclusion, different location of ulcer in the stomach results in a characteristic serum PGI level.     

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．     

Effect of proximal gastric vagotomy on serum pepsinogen I and II concentrations and acid secretion in duodenal ulcer patients

Acid secretion and basal serum pepsinogen I and II concentrations were measured in 14 duodenal ulcer patients before and at intervals up to six years after proximal gastric vagotomy. Vagotomy led to significant and long-standing reductions in basal, vagally mediated (induced by sham feeding), and peak pentagastrin-stimulated acid secretion. Serum pepsinogen I concentrations also decreased significantly after vagotomy but to a significantly lesser extent than acid secretion. There was no correlation between serum pepsinogen I concentrations and peak acid secretion, either before or after vagotomy. Serum pepsinogen II concentrations decreased only slightly and transiently after vagotomy. Thus, proximal gastric vagotomy reduces acid hypersecretion and pepsinogen I hypersecretion, but not pepsinogen II hypersecretion, in duodenal ulcer patients. This work was supported by a grant from the Veterans Administration, the National Institutes of Health (AM 16816), and the Berta M. and Cecil O. Patterson Endowment Fund in Digestive Disease.     

Serum pepsinogen I concentrations in peptic ulcer patients in relation to ulcer location and stage.

To investigate the relation of the serum group I pepsinogen (PG I) concentration to the location of gastric ulcers and chronicity of peptic ulcers, ulcer patients (n = 322) were compared with endoscopically normal subjects (n = 174). The mean PG I concentration was significantly higher in male control subjects (n = 90) than in female control subjects (n = 84). In male patients with ulcers in the duodenum (n = 69), antrum (n = 34), or angulus portion (the lower third of the body; n = 83), the mean serum PG I concentration was significantly higher than in the control subjects but in patients with an ulcer in the upper body (n = 49) it was similar to control values. Men with active or healing ulcers (n = 149) showed a significantly higher serum PG I concentration than those with scarred lesions (n = 86) when the abnormality was located in either the upper body or in the angulus portion. For female patients (n = 87), the results were similar. These results suggest that serum PG I concentrations reflect the stages of activity of peptic ulcer.     

Seasonal variation of peptic ulcer disease,peptic ulcer bleeding,and acute pancreatitis: A nationwide population-based study using a common data model

Although gastrointestinal diseases are reported at various times throughout the year, some particular seasons are associated with a higher incidence of these diseases. This study aimed to identify the seasonal variations of peptic ulcer (PU), peptic ulcer bleeding (PUB), and acute pancreatitis (AP) in South Korea.We conducted a retrospective, observational cohort study of all subjects aged >18 years between 2012 and 2016 using the Health Insurance Review and Assessment-National Patient Samples database, previously converted to the standardized Observational Medical Outcomes Partnership-Common Data Model. We assessed the overall seasonal variations of PU, PUB, and AP and further analyzed seasonal variations according to age and sex subgroups.In total, 14,626 patients with PU, 3575 with PUB, and 9023 with AP were analyzed for 5 years. A clear seasonal variation was noted in PU, with the highest incidence rate during winter, the second highest during spring, the third highest during summer, and the lowest incidence during autumn for 5 years (P < .001). PUB also showed significant seasonal fluctuations, with winter peak for 4 years, except 1 year, which had a spring peak (P < .001). However, AP showed no clear seasonal variations (P = .090). No significant differences in the seasonal variation of PU, PUB, and AP were observed according to sex and age subgroups (<60 years vs ≥60 years).Seasonal variation of PU and PUB should be considered when determining allocation of available health care resources.     

Serum pepsinogen I levels of gastric ulcer patients are determined by the location of the ulcer crater.

To examine the relation between gastric ulcer (GU) location and serum pepsinogen I (PGI) level, we measured this marker in 284 endoscopically proved GU patients. Their ulcer locations were further divided according to Johnson's criteria modified to the corpus (type 1a), gastric angle (type 1b), combined with duodenal ulcer (type 2) and prepyloric area (type 3). The number of each subset were 96, 81, 58 and 49, respectively. Mean serum PGI level (99.6 +/- 44.8 ng/ml) of all GU patients showed no difference from that of their sex and age matched controls. Mean serum PGI levels in both type 1a and 1b patients, did not differ from each other but were significantly lower than in controls, in contrast to those in type 2 and 3 patients which were significantly higher than in controls and comparable to the PGI levels of patients with duodenal ulcer. Smoking did not affect mean serum PGI levels in all subsets except the smoking type 2 patients who manifested a significantly higher mean PGI level. Helicobacter pylori infection did not show different serum PGI levels in any subset. In conclusion, different location of ulcer in the stomach results in a characteristic serum PGI level.