Campylobacter pylori infection in gastric and duodenal ulcer

The incidence of infection with Campylobacter pylori (CP) in gastric ulcer (GU) and duodenal ulcer (DU) and its correlation with the gastritis lesions associated to the two diseases, was investigated. In GU the incidence of CP infection was 76.3%, close to that in DU (71.4), but different from controls (33.3%). Chronic gastritis associated to gastric or duodenal ulcer is of variable severity, CP infection being the more often encountered the higher the severity of gastritis. Presence of CP was also observed in 75% of the cases associated also with intestinal metaplasia from UG. The diameter of CP-positive GU was significantly increased as compared with that in CP-negative GU. Type I GU was associated with CP infection in 81.8% of the cases. The results obtained allowed the conclusion that in GU and DU the incidence of CP infection is significantly higher as compared with that in controls but the pathogenetic relationship ulcer-bacterium is not yet elucidated.

Herpes simplex and duodenal ulcer pathology

An association between Herpes simplex Virus 1 (HSV-1) and duodenal ulcer disease has been suggested. Duodenal ulcers, like HSV-1 lesions, exhibit periodicity in recurrence. Several of the presently available anti-ulcer agents may have an antiviral action. Antibody titres in some studies have shown selective increases to HSV-1 in duodenal ulcer patients. The aim of this study was to determine whether a real association exists between HSV-1 and endoscopically proven duodenal ulcer or duodenal erosive disease. In a prospective study, 27 patients with either duodenal ulcer (16) or duodenal erosions (11) were studied in order to attempt isolation of HSV-1. Acute and convalescent sera were also taken and examined by an enzyme linked-immunoabsorbent assay system for antibody titres to HSV-1. Duodenal biopsies from a further 26 patients with duodenal ulcer or erosive disease were also examined retrospectively for HSV-1 by the immunoperoxidase technique. In no case of either duodenal ulcer or duodenal erosive disease was HSV-1 isolated by any of the above methods, nor was a relationship demonstrated by acute or convalescent HSV-1 antibody titres. Hence, this study does not support an association between HSV-1 and duodenal ulcer or erosive disease.

Adult acquired cytomegalovirus infection with gastric and duodenal ulceration

Recent reports of cytomegalovirus associated colonic and oesophageal ulceration in immunosuppressed patients infected with the human immunodeficiency virus, have focused attention on the possibility that viral infections may in some cases be the initial insult which leads in susceptible subjects to gastrointestinal ulceration. In this case report we describe how systemic primary infection with the cytomegalovirus was associated with the development of multiple gastric and duodenal erosions.

Aetiology of ulcers

It seems that duodenal and gastric ulcers are caused by environmental ulcerogens, which are probably infectious or chemical. The reasons for individual susceptibility to these ulcerogens have not been defined and, indeed, it is not yet certain that the effects are not essentially random. Abnormalities of function of the mucosae of the upper alimentary tract do not appear to be necessary or sufficient for the production of ulcers. The two principal clinical aspects of ulcer disease--the tendency to form chronic mucosal wounds and the tendency of the wounds to recur during many years--point to, but cannot yet be explained in terms of, failure of the processes involved in wound repair. More specifically, it is not known whether there is interference with the processes involved in normal mucosal repair or whether there is failure of the repair processes. When these problems are closer to solution, it will perhaps be possible to assess how environmental factors influence ulcerogenesis.

The geography of chronic digestive disease in southern Africa

Lifestyle and dietary patterns are in the process of rapid transformation in Soweto. Comparisons with whites indicate differences in bowel behaviour, lactase deficiency and breath methanes. The association between smoking pipe tobacco and cancer of the oesophagus is confirmed, but home-brew consumption has been found to be the major risk factor in this cancer. A recent swing to Western-type alcohol has led to the emergence of alcohol-induced pancreatitis in blacks. Urbanisation and westernisation have also affected the influence of the traditional healer and the incidence of duodenal ulcer disease. The fundamental environmental influence which determines non-infective large-bowel disease is diet. A dietary survey of Sowetans indicates that their present diet is low in fat and fibre. Despite the latter, appendicitis is still relatively uncommon. Other significant differences are observed in colorectal cancer and diverticular disease.

Serum pepsinogen I elevation in cigarette smokers

We measured serum pepsinogen I (sPG-I) in 269 patients undergoing upper GI endoscopy and then classified by endoscopic diagnosis, gastric mucosal histology, and smoking habit. Both ulcer-free and duodenal ulcer smokers had significantly higher sPG-I levels than their non-smoking controls. In contrast, sPG-I values were not different in smokers and non-smokers with gastric ulcer. In ulcer-free smokers the overall increase in sPG-I simply reflected the high prevalence of patients with superficial gastritis and elevated sPG-I levels. Conversely, in duodenal ulcer smokers the increase in sPG-I, which was related to the number of cigarettes smoked daily, was not an epiphenomenon of concomitant gastritis. The smoking-induced increase in sPG-I in duodenal ulcer is proposed to reflect an augmented pepsin secretory capacity, which can be of aetiologic significance in the association between cigarette smoking and duodenal ulcer.

Peptic ulcer in rheumatoid arthritis

In a study of patients attending a rheumatology clinic 230 unselected patients, 185 with rheumatoid arthritis (RA) and 45 with other rheumatic disorders (non-RA), were examined by endoscopy and a detailed history of symptoms referable to the gastrointestinal tract was taken. A peptic ulcer was found in 67 (36%) of the patients and in 13 (29%) of the non-RA group. Gastric ulceration was more common in the group with RA (32 patients (17%) compared with three patients (7%) in the non-RA group); 17/32 (53%) patients with RA and gastric ulcer were asymptomatic. In the group with RA, of those with gastric ulcer 20/32 (63%) were smokers, compared with only 40/118 (34%) of the non-ulcer group. There was no difference in the duration of rheumatic disease or non-steroidal anti-inflammatory drug (NSAID) treatment between the ulcer and non-ulcer groups. Treatment with H2 receptor antagonist and maintenance of NSAID treatment resulted in healing in 26 out of 29 (90%) patients with gastric ulcer and 23 out of 27 (85%) patients with duodenal ulcer.

[Effects of dopamine receptor agonists and antagonists on an experimental ulcer system induced by cysteamine in rats--dopaminergic mechanism vs pathogenesis of peptic ulceration]

The physiological roles of sympathetic nerve system in the stomach has been thought to be very important in the pathogenesis of peptic ulceration. The aim of this study was to examine the effects of dopamine receptor agonists and antagonists on gastric acid secretion and gastroduodenal ulcer formation induced by cysteamine injection in rats. Cysteamine was given by subcutaneous injection as 400mg/kg in doses. Dopamine was given by continuous iv infusion as 2, 4 and 8 micrograms/kg/min in doses. Domperidone regarded as antagonists of D2 receptor was given by continuous iv infusion as 2 micrograms/kg/min in doses. As a result of acid output measured during infusion of dopamine alone or dopamine with domperidone in non-vagotomized or vagotomized rats, increasing effects of dopamine on acid output were depended on dopaminergic mechanism, and decreasing effects of dopamine on acid output were depended on dopaminergic mechanism in rami vagus. As a result of duodenal and gastric ulcer index, ulcerogenicity of cysteamine in the stomach was concerned with dopaminergic mechanism more than that of in the duodenum. These results suggested that the pathogenesis of experimental ulcer induced by cysteamine injection was depended on dopamine receptor in the stomach.

[Campylobacter pylori: cause of gastritis and ulcer disease?]

Several studies have shown a striking association between the presence of Campylobacter pylori (C.p) in the gastric mucosa and histologically confirmed gastritis and ulcer disease. The microorganism has been found in up to 90% of patients with active chronic antral (type B) gastric ulcer, and in up to 70% of patients with duodenal ulcer. Voluntary ingestion of C.p. by two persons and two epidemic occurrences after apparent C.p. contamination of stomach probes, with demonstration of the bacterium in the mucosa, have shown that C.p. can induce acute gastritis; in one volunteer the acute gastritis progressed to the active chronic form. Eradication of C.p. by antibacterial treatment is associated with resolution of gastritis. Relapse of peptic ulcer is closely related to infection by C.p. The microorganism has important virulence factors allowing it to select an ecological niche below the mucus layer on the gastric mucosa. C.p. exhibits strong mucolytic activity through proteases which could damage the mucus barrier and therefore increase susceptibility to development of gastritis and peptic ulcers; however, the pathogenic impact of C.p. remains unknown. C.p. is diagnosed by histological or microbiological examination of gastric biopsy specimens or by serological techniques. Bismuth salts alone or in combination with antibiotics are effective against C.p., but the efficacy of antimicrobial treatment of gastritis and ulcer disease associated with C.p. has still to be proven by large double-blind placebo-controlled trials. The hitherto published findings do not allow definite evaluation of the pathogenetic significance of C.p. in gastritis and ulcer disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Nicotine and the gastrointestinal tract]

Reflux esophagitis occurs much more often in smokers because of reduction of saliva production and lessened tonus of the LES (lower esophageal sphincter). Duodenal ulcers heal during H2-blocking agents in smokers slower than during placebo-therapy in non smokers. Mortality of duodenal ulcer in smokers is 2 to 7 times increased.

Acid secretion and serum gastrin levels in individuals with Campylobacter pylori

Campylobacter pylori may cause gastritis and has been proposed as an etiologic factor in the development of peptic ulcer. However, it may be an acid-sensitive microbe and before it can be implicated in the pathogenesis of peptic ulcer, it should be consistently found in ulcer patients with normal acid secretion. Thirty-six patients with C. pylori by Warthin-Starry stain underwent gastric analysis; 25 were normochlorhydric and 11 hypochlorhydric. Ulcers were present in 19 normochlorhydric patients (10, gastric; 9, duodenal) and 2 hypochlorhydric patients (gastric). Median basal acid output was higher for those with duodenal ulcer (38 mmol/h) than gastric ulcer (28 mmol/h) or miscellaneous endoscopic features (33 mmol/h). The hypergastrinemia seen in 12 patients with negative secretin provocation tests was believed to be due to various nongastrinoma conditions. Campylobacter pylori was found in 6 normogastrinemic patients with elevated acid output and in 1 gastrinoma patient with marked acid hypersecretion. Histologic chronic gastritis was present in all subjects and 29 had active chronic gastritis. Twenty-three patients were taking H2-receptor antagonists at the time of diagnosis which did not seem to interfere with culture results. Using standard acid secretory tests, we conclude that C. pylori can survive in a wide range of acid conditions.