Study on the role of gastric Helicobacter infection in gross pathological and histological lesions of the stomach in finishing pigs

The prevalence of gastric Helicobacter infection in finishing pigs and the influence of this infection on gastric lesions was studied. Stomachs of 89 finishing pigs from 27 randomly selected herds were sampled at the slaughterhouse. Forty cases (Group A) were selected based upon the presence of gross pathological lesions in the pars oesophagea, and further 49 cases were obtained at random (Group B). Three samples of gastric tissue (junction of pars oesophagea and pars cardiaca, fundic area, and pyloric area) were collected from each stomach for histological and immunohistochemical examination. Helicobacter antigen was detected in 76 cases (85.4%). No association was found between the presence of Helicobacter in the stomach and the occurrence of gross pathological lesions in the pars oesophagea or gastritis detected on histological examination. However, a significant association was found between the occurrence of Helicobacter in the pyloric area and the presence of erosions/ulcers in the pars oesophagea (OR: 7.01, p = 0.022) in Group B. A significant association was also evident between the presence of Helicobacter and glandular lesions (dilatation of the glands + glandular abscess + degeneration of glandular epithelial cells). In conclusion, Helicobacter infection seems to be a contributing factor to pathological changes in the stomach of finishing pigs.

Gastric eosinophilic granuloma in China: case series

AIM

Eosinophilic granulomas are benign localized lesions in the stomach that are distinct from eosinophilic gastritis. The aim of this study was to identify the potential etiological factors and clinical features of gastric eosinophilic granulomas (GEG).

METHODS

Clinical manifestations, histopathological features, diagnosis and treatments of 48 hospitalized cases of GEG were analyzed retrospectively. A modified Giemsa staining was employed to detect Helicobacter pylori in 23 of these 48 patients.

RESULTS

There was a significant gender difference among patients with GEG with male patients significantly more affected than female patients. The final diagnosis was made after operating the patients (the misdiagnosis level was rather high before resection). Lymphoid follicles were found in 68.6% of the tissues surrounding the lesion. H. pylori infection was detected in 69.6% of patients. In 11 patients eosinophilia in the peripheral blood was observed.

CONCLUSION

The results suggest that H. pylori infection, estrogen status and local allergic reactions may be associated with the development of GEG.

Work-related psychosocial factors, worry about work conditions and health complaints among female and male ambulance personnel

This study aimed at investigating the relationships between work-related psychosocial factors, worry about work conditions and health complaints (sleeping problems, headache and stomach symptoms) among female and male ambulance personnel. Out of 4000 ambulance personnel in Sweden, 1500 (300 female and 1200 male personnel) were randomly selected. They answered a questionnaire including items on self-reported health complaints, individual characteristics, work-related psychological demands, decision latitude, social support and worry about work conditions. Twenty-five per cent of the female and 20% of the male ambulance personnel reported two or more health complaints sometimes or often. According to the demand-control-support questionnaire, ambulance personnel reported a generally positive psychosocial work environment, although psychological demands were associated with sleeping problems, headache and stomach symptoms among both female and male ambulance personnel. Another factor that was significantly associated with health complaints among both genders was worry about work conditions. When worry about work conditions was added to the regression models, this variable took over the role from psychological demands as a predictor for health complaints among the female ambulance personnel. The prevalence of sleeping problems, headache and stomach symptoms were significantly associated with psychological demands among both female and male ambulance personnel. Notably, worry about work conditions seems to be an important risk factor for health complaints. This suggests that worry about work conditions should not be neglected when considering risk factors among ambulance personnel.

Prevalence of recurrent physical symptoms in U.S. adolescents

PURPOSE

To estimate the prevalence of 10 recurrent physical symptoms and to examine how prevalence differs by gender and age in healthy American adolescents.

METHOD

Cross-sectional analysis used survey data from the National Longitudinal Study of Adolescent Health (Add Health), a school-based probability sample of over 20,000 adolescents in grades 7 through 12.

FINDINGS

Headache was the most frequently reported symptom (29%), closely followed by musculoskeletal pain (27%), fatigue (21%), and stomachache (18%). About one third of the adolescents reported multiple symptoms. Nonlinear age trends were found for musculoskeletal pain, fatigue, and dizziness with peaks between ages 16 and 17. Prevalence was higher in girls for most symptoms except musculoskeletal pain. Multiple symptoms were also prevalent and varied according to age and gender.

CONCLUSIONS

The findings provide a database for studying health problems in adolescents. The high prevalence of physical symptoms underscores the importance of incorporating symptom assessment into adolescent physical check-ups at schools and communities as well as during sick office visits. This helps nurses strategize screening of adolescents.

Prevalence of gastrointestinal tract lesions in 73 brachycephalic dogs with upper respiratory syndrome

OBJECTIVES

To determine the prevalence of gastrointestinal tract lesions in brachycephalic dogs with upper respiratory tract disease.

METHODS

The gastrointestinal tract and respiratory disorders of 73 brachycephalic dogs presented with upper respiratory signs were evaluated. Clinical signs and endoscopic and histological anomalies of the upper digestive tract were analysed.

RESULTS

A very high prevalence of gastrointestinal tract problems in brachycephalic dogs presented with upper respiratory problems was observed clinically, endoscopically and histologically. Endoscopic anomalies of the upper digestive tract were present even in dogs without digestive clinical signs. Furthermore, histological evaluation of the digestive tract sometimes showed inflammatory lesions not macroscopically visible at endoscopy. Statistical analysis showed a relationship between the severity of the respiratory and digestive signs. This was significant in French bulldogs, males and heavy brachycephalic dogs.

CLINICAL SIGNIFICANCE

These observations show a correlation between upper respiratory and gastrointestinal tract problems in brachycephalic breeds with upper respiratory disease. Surgical treatment of respiratory disease could improve the digestive clinical signs, and/or gastro-oesophageal medical treatment could improve the outcome for surgically treated brachycephalic dogs.

Gastroduodenal cytomegalovirus infection is common in kidney transplantation patients

OBJECTIVE

Cytomegalovirus (CMV) infection is known to cause ulcerations, erosion and mucosal haemorrhage in the gastrointestinal tract. The aim of this study was to report the CMV findings in the gastroduodenal mucosa of kidney transplantation patients and immunocompetent controls.

MATERIAL AND METHODS

Forty-six kidney transplant patients with upper gastrointestinal symptoms and 43 immunocompetent, dyspeptic patients (controls) prospectively underwent oesophagogastroduodenoscopies (OEGDs), with biopsies from the duodenum and stomach. CMV was demonstrated by immunohistochemistry, both in frozen sections using a monoclonal antibody against CMV-specific antigens (pp65 matrix protein) and in paraffin sections by means of a monoclonal antibody against the delayed early protein (p52).

RESULTS

CMV was detected in the gastric mucosa in 30% of the kidney transplant patients and in 9% of the controls (p<0.05) and in the duodenal mucosa in 70% and 35%, respectively (p<0.01). The total frequency of CMV findings was similar in patients who underwent OEGDs <1 year and >1 year after transplantation. CMV inclusions were found only in transplantation patients <1 year after transplantation (n=9). CMV findings, especially inclusions, in the gastric biopsies were associated with nausea and upper gastric pain. Histopathological findings in CMV-positive samples were non-specific, focal inflammation in haematoxylin-eosin-stained preparations, while CMV p52 staining showed inclusions in either the epithelial or endothelial cells.

CONCLUSIONS

CMV could be detected in the gastroduodenal mucosa in 74% of kidney transplantation patients and in 40% of immunocompetent controls (p<0.01). CMV diagnostics are always recommended when gastroduodenal biopsies of kidney transplantation patients are performed.

Genetic selection for health traits using producer-recorded data. II. Genetic correlations, disease probabilities, and relationships with existing traits

The objectives of this study were to calculate genetic correlations between health traits that were recorded in on-farm herd management software programs and to assess relationships between these traits and other traits that are routinely evaluated in US dairy sires. Data consisted of 272,576 lactation incidence records for displaced abomasum (DA), ketosis (KET), mastitis (MAST), lameness (LAME), cystic ovaries (CYST), and metritis (MET) from 161,622 cows in 646 herds. These data were collected between January 1, 2001 and December 31, 2003 in herds using the Dairy Comp 305, DHI-Plus, or PCDART herd management software programs. Binary incidence data for all disorders were analyzed simultaneously using a multiple-trait threshold sire model that included random sire and herd-year-season of calving effects. Although data from multiple lactations were available for some animals, our genetic analysis included only first parity records due to concerns about selection bias and improper modeling of the covariance structure. Heritability estimates for the presence or absence of each disorder during first lactation were 0.14 for DA, 0.06 for KET, 0.09 for MAST, 0.03 for LAME, 0.04 for CYST, and 0.06 for MET. Estimated genetic correlations were 0.45 between DA and KET, 0.42 between KET and CYST, 0.20 between MAST and LAME, 0.19 between KET and LAME, 0.17 between DA and CYST, 0.17 between KET and LAME, 0.17 between KET and MET, and 0.16 between LAME and CYST. All other correlations were negligible. Correlations between predicted transmitting abilities for the aforementioned health traits and existing production, type, and fitness traits were low, though it must be noted that these estimates may have been biased by low reliability of the health trait evaluations. Based on results of this study, it appears that genetic selection for health disorders recorded in on-farm software programs can be effective. These traits can be incorporated into selection indices directly, or they can be combined into composite traits, such as "reproductive disorders", "metabolic disorders", or "early lactation disorders".

Genetic selection for health traits using producer-recorded data. I. Incidence rates, heritability estimates, and sire breeding values

The objective of this study was to determine the feasibility of genetic selection for health traits in dairy cattle using data recorded in on-farm herd management software programs. Data regarding displaced abomasum (DA), ketosis (KET), mastitis (MAST), lameness (LAME), cystic ovaries (CYST), and metritis (MET) were collected between January 1, 2001 and December 31, 2003 in herds using Dairy Comp 305, DHI-Plus, or PCDART herd management software programs. All herds in this study were either participants in the Alta Genetics (Watertown, WI) Advantage progeny testing program or customers of the Dairy Records Management Systems (Raleigh, NC) processing center. Minimum lactation incidence rates were applied to ensure adequate reporting of these disorders within individual herds. After editing, DA, KET, MAST, LAME, CYST, and MET data from 75,252 (313), 52,898 (250), 105,029 (429), 50,611 (212), 65,080 (340), and 97,318 (418) cows (herds) remained for analysis. Average lactation incidence rates were 0.03, 0.10, 0.20, 0.10, 0.08, and 0.21 for DA, KET, MAST, LAME, CYST, and MET (including retained placenta), respectively. Data for each disorder were analyzed separately using a threshold sire model that included a fixed parity effect and random sire and herd-year-season of calving effects; both first lactation and all lactation analyses were carried out. Heritability estimates from first lactation (all lactation) analyses were 0.18 (0.15) for DA, 0.11 (0.06) for KET, 0.10 (0.09) for MAST, 0.07 (0.06) for LAME, 0.08 (0.05) for CYST, and 0.08 (0.07) for MET. Corresponding heritability estimates for the pooled incidence rate of all diseases between calving and 50 d postpartum were 0.12 and 0.10 for the first and all lactation analyses, respectively. Mean differences in PTA for probability of disease between the 10 best and 10 worst sires were 0.034 for DA, 0.069 for KET, 0.130 for MAST, 0.054 for LAME, 0.039 for CYST, and 0.120 for MET. Based on the results of this study, it appears that genetic selection against common health disorders using data from on-farm recording systems is possible.

[Serological profile of Helicobacter pylori infection in the population of San Luis (Argentina)]

We performed a seroepidemiological study of anti-Helicobacter pylori IgG by a commercial enzyme immunoassay kit (Meridian Diagnostics, USA) in 509 serum samples from 314 randomly selected asymptomatic subjects from among the population, and grouped into children (n = 124), adolescents (n = 74) and adults (n = 116), and in 195 serum samples from subjects presenting clinical gastric symptoms, grouped into children (n = 38) and adults (n = 157). The cut-off value was redefined and set at OD450 = 0.050. The percentage of seropositive individuals was not significantly different between the two groups of adults studied (75.9% and 80.2%, respectively) (p < 0.05), suggesting a high degree of contact with the microorganism in this region.

Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity

BACKGROUND

Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass (LRYGBP) present with dysphagia, nausea, and vomiting. Diagnosis is made by endoscopy and/or radiographic studies. Therapeutic options include endoscopic dilation and surgical revision.

METHODS

Of 369 LRYGBP performed, 19 patients developed anastomotic stricture (5.1%). One additional patient was referred from another facility. Pneumatic balloons were used for initial dilation in all patients. Savary-Gilliard bougies were used for some of the subsequent dilations.

RESULTS

Flexible endoscopy was diagnostic in all 20 patients allowing dilation in 18 (90%). Two patients did not undergo endoscopic dilation because of anastomotic obstruction and ulcer. The median time to stricture development was 32 days (range: 17-85). Most patients (78%) required more than two dilations. The complication rate was 1.6% (one case of microperforation). At a mean follow-up of 21 months, all patients were symptom-free.

CONCLUSIONS

Gastrojejunostomy stricture following LRYGBP is associated with substantial morbidity and patient dissatisfaction. Based on our experience, we propose a clinical grading system and present our strategy for managing gastrojejunal strictures.

Statistical modelling of the spatial distribution of prevalence of Calicophoron daubneyi infection in sheep from central Italy

Statistical modelling for Disease Mapping and Ecological Analysis is of particular importance in veterinary parasitology because environmental characteristics can affect parasite distribution. However, the main difficulties relate to the concentration of animal populations within farms, which contrasts to the study of wild animal populations. In the present paper we report the results of a cross-sectional coprological survey designed to study the presence and distribution of the rumen fluke Calicophoron daubneyi--which causes paramphistomosis, a snail borne disease--in pastured sheep living in the Latina province of central Italy. We show how techniques derived from human epidemiology can be used to study the spatial distribution of parasite infection in animals. We proposed a hierarchical Bayesian model with random terms for unstructured variability (heterogeneity) to account for local farm characteristics and spatially structure terms (clustering) to cope with medium-large scale environmental characteristics.

Genetic Basis and Risk Factors for Infectious and Noninfectious Diseases in US Holsteins. I. Estimation of Genetic Parameters for Single Diseases and General Health

Health data collected from 1996 to 1999 from 177 herds in Minnesota and Wisconsin were analyzed to establish genetic basis for infectious and noninfectious diseases. Three types of health traits were targeted. First, available infectious conditions were used to identify animals that are superior in their general immunity (including innate immunity) for infectious diseases. Generalized immunity may be thought of as a combination of immune responses to a variety of immune system challenges. Second, single infectious and noninfectious diseases were analyzed separately. Third, infectious reproductive diseases as one category of related conditions, and cystic ovary disease as one category of 3 related noninfectious ovary disorders were studied. Data were analyzed using a threshold model that included herd, calving year, season of calving, and parity as cross-classified fixed factors; and sire and cow within sires as random effects. Days at risk and days in milk at the beginning of a record were included by fitting the days as continuous covariates in the model. A heritability value of 0.202 +/- 0.083 was estimated for generalized immunity. Heritability values of 0.141 and 0.161 were estimated for uterine infection and mastitis, respectively. Heritability of single noninfectious disorders ranged from 0.087 to 0.349. The amount of additive genetic variance recovered in the underlying scale of noninfectious disorders tended to zero when combining multiple conditions. The study supports combining infectious diseases into categories of interest but we do not recommend the same approach for noninfectious disorders.

The Changing Prevalence of Helicobacter Pylori Infection in Canadian Children: Should Screening Be Performed in High-Risk Children?

While several studies have demonstrated a decline in the overall prevalence of Helicobacter pylori infection in developed countries, there is variability in the burden of infection linked to socioeconomic status and living conditions. Improved socioeconomic status, living conditions and the availability of H pylori-eradication therapy have been associated with a lower prevalence of infection in First World populations, yet immigrants and indigenous people continue to have a high burden of H pylori infection and disease. Although the changing prevalence of H pylori infection in children has been recognized in a few reports, further studies are required to determine the impact of H pylori infection in this population. Moreover, additional studies are required for those populations at risk.

The influence of surgical volume on hospital mortality and 5-year survival for carcinoma of the oesophagus and gastric cardia

OBJECTIVE

To study the effects of hospital operation volume on hospital mortality and 5-year survival in patients treated with resection for carcinoma of the oesophagus and gastric cardia.

INTRODUCTION

Surgery due to tumours of the oesophagus and gastric cardia is probably associated with the highest postoperative morbidity and mortality of all elective surgical procedures. Concentration to high-volume centres has been suggested to improve the outcome.

MATERIALS AND METHODS

Between 1987 and 1996, all patients with squamous cell carcinoma or adenocarcinoma of the oesophagus or gastric cardia were identified from the Swedish Cancer Registry and the Swedish Hospital Discharge Registry. The study population was assessed according to patients operated at hospitals with a low (L-V), intermediate (I-V) or high operation volume (H-V), defined as <5 resections/year, 5-15 resections/year and >15 resections/year, respectively. We analyzed hospital mortality and 5-year survival.

RESULTS

During the study period, 1429 patients were treated with resection for carcinoma of the oesophagus (n=665) or the gastric cardia (n = 764). A total of 74 hospitals were registered with at least one surgical resection, of which 90% performed <5 resections/year. The distribution of gender and age was comparable in the three groups. Hospital mortality was 10.4, 6.3 and 3.5% in the L-V, I-V and H-V groups, respectively. Overall 5-year survival was 17% (L-V), 19% (I-V) and 22% (H-V). Multivariate analysis showed an improved long-term survival for patients operated at H-V compared to L-V hospitals (p=0.02).

CONCLUSION

This study supports an inverse relationship between hospital volume and hospital mortality after surgical tumour resection of the oesophagus or gastric cardia. Overall 5-year survival was significantly higher at high-volume hospitals compared to low-volume centres. We believe that concentrating these patients in high-volume hospitals is necessary to achieve high quality surgical treatment and to facilitate research aiming to improve prognosis.

[Treatment of patients with combined burn strictures of the esophagus and stomach]

The authors made an analysis of their experiences with treatment of 52 patients. The algorithm of examinations and treatment depending on the character of the injury of the esophagus and stomach is described. Positive results were obtained in 90% of the patients.

Portal hypertensive gastropathy

Portal hypertensive gastropathy (PHG) is the term used to describe the endoscopic appearance of gastric mucosa seen in patients with cirrhotic or non-cirrhotic portal hypertension with a characteristic mosaic-like pattern with or without red spots. The prevalence of PHG varies from 50% to 98%, this variation of the prevalence being perhaps related to patient selection, inter- and intra-observer variation and absence of uniform criteria and classification. About 8% of the upper digestive hemorrhages in the cirrhotic patients are secondary to PHG. There is no general consensus on the endoscopic classification of PHG (the most New Italian Endoscopy Club). The exact pathogenesis of PHG is not completely understood, but the portal hypertension is the main factor involved in its development and not the severity of the hepatic disease. Gastric Antral Vascular Ectasia (GAVE) is a term used for the typical endoscopic findings of red stripes, separated by normal mucosa, most frequently seen in the gastric antrum or proximal stomach. Current therapy of PHG includes beta blockers, somatostatin and derivates, endoscopic and surgical methods including hepatic transplantation.

ABOMASAL PARASITES IN WILD SYMPATRIC CERVIDS, RED DEER, CERVUS ELAPHUS AND FALLOW DEER, DAMA DAMA, FROM THREE LOCALITIES ACROSS CENTRAL AND WESTERN SPAIN: RELATIONSHIP TO HOST DENSITY AND PARK MANAGEMENT

A survey of abomasal parasites in cervids from Central Spain was conducted at 3 sites, Quintos de Mora (Toledo), Maluéñez de Arriba (Cáceres), and La Herguijuela (Cáceres). Commonly occurring helminths belonged to 3 polymorphic species of the Ostertagiinae: Spiculopteragia asymmetricalS. quadrispiculata, Ostertagia leptospicularis/O. kolchida, and O. drozdzi/O. ryjikovi. Trichostrongylus axei was found in very few cases. Ostertagia drozdzi/O. ryjikovi and the minor male morphotype, S. quadrispiculata, are reported for the first time in red deer from Spain. The 3 ostertagiine species are also reported for the first time in fallow deer from Spain. These 3 species of Ostertagiinae are primarily parasites of cervids, and nematode species characteristic of domestic ruminants were not present. Prevalence of infection by gastrointestinal parasites in cervids was high, ranging from 97.5 to 100%, across the 3 areas sampled. Mean intensity of infection and abundance showed a positive relationship to the population density of red deer. Helminth burdens were higher in fallow deer than in the sympatric red deer and may reflect the gregarious social structure and different foraging patterns of fallow deer.

Detection of cardia intestinal metaplasia: do the biopsy number and location matter?

BACKGROUND AND AIM

Presence of intestinal metaplasia in the gastric cardia (cardia intestinal metaplasia, CIM) has been reported in 5-34% of patients undergoing upper endoscopy and is a topic of interest given the rising incidence of cancer in this location. The aim of this article is to determine the prevalence of CIM in biopsies obtained from two separate locations within the gastric cardia.

METHODS

Patients presenting to the endoscopy unit for upper endoscopy for any symptoms were invited to participate in the study. The biopsy protocol included: eight biopsies from the gastric cardia, four from upper cardia (forceps across the squamocolumnar junction), four from lower cardia (within 1 cm of upper cardia), and four each from the gastric body and antrum. All cardia biopsies were stained with hematoxylin and eosin (H&E) and alcian blue at pH 2.5 for the presence of goblet cells and the body/antrum biopsies were stained with Steiner silver stain for Helicobacter pylori detection. In patients testing negative for H. pylori by histology, a serology test was performed.

RESULTS

Sixty-five patients have been evaluated by this protocol; median age 54 yr (range: 34-81 yr), 63 males, 53 Caucasians, and 12 African Americans. The detection of CIM was as follows: upper cardia only, 7, both upper and lower cardia, 5, and lower cardia only, 7. Thus, CIM was detected in 12 patients (18%) in the upper cardia biopsies, in 12 patients (18%) in the lower cardia; overall prevalence of CIM was 29% (19 patients). Fifty-eight percent of CIM patients tested positive for H. pylori by either histology or serology. The addition of serology allowed for the detection of eight additional H. pylori-positive CIM patients.

CONCLUSIONS

The prevalence of CIM in this study was similar (18%, four biopsies) at each location; however, if both locations were considered (eight biopsies), the prevalence increased to 29%. Thus, CIM prevalence may vary depending on the number of biopsies obtained as well as on the location of biopsies. Use of additional testing detects more patients who are H. pylori positive and should be performed if association of CIM with H. pylori is contemplated. Future endoscopic studies of the gastric cardia should specify the location of biopsies, the number of biopsies obtained, and the tests used to diagnose H. pylori.

Prevalence of Soboliphyme baturini in marten (Martes americana) populations from three regions of Alaska, 1990-1998

Marten (Martes americana) carcasses were collected from trappers in three regions of Alaska. Stomachs were examined for the nematode parasite Soboliphyme baturini. Both prevalence and intensity of infection exhibited an increase from north to south. Prevalence was higher in adults (compared with juveniles) from the two mainland study areas. Prevalences in these two age classes were similar for the southeastern region. There were no sex-specific differences in prevalence. No pathologic changes were observed in the gastrointestinal tract. Impact of the parasite on either individual animals or populations was not detected.

The natural history of portal hypertensive gastropathy in patients with liver cirrhosis and mild portal hypertension

BACKGROUND

Portal hypertensive gastropathy is a potential cause of bleeding in patients with liver cirrhosis. Studies on its natural history have often included patients submitted to endoscopic or pharmacological treatment for portal hypertension.

PATIENTS AND METHODS

A total of 222 cirrhotic patients with mild degree of portal hypertension (i.e., with no or small varices at entry, without previous gastrointestinal bleeding and medical, endoscopic, or angiographic treatment) were followed up with upper endoscopy every 12 months for 47 +/- 28 months.

RESULTS

Upon enrollment 48 patients presented portal hypertensive gastropathy (43 mild and 5 severe) and the presence of esophageal varices was the only independent predictor of the presence of this gastric lesion at multivariate analysis. The incidence of portal hypertensive gastropathy was 3.0% (1.1-4.9%) at 1 yr and 24% (18.1-29.9%) at 3 yr, while the progression was 3% (1-6.9%) at 1 yr and 14% (4.2-23.8%) at 3 yr. The presence of esophageal varices and the Child-Pugh class B or C at enrollment were predictive of the incidence of portal hypertensive gastropathy, while only Child-Pugh class B or C was correlated with the progression from mild to severe, at multivariate analysis. During follow-up 16 patients bled from portal hypertensive gastropathy (9 acutely and 7 chronically) and one patient died of exsanguination from this lesion.

CONCLUSIONS

The natural history of portal hypertensive gastropathy is significantly influenced by the severity of liver disease and severity of portal hypertension. Acute bleeding from portal hypertensive gastropathy is infrequent but may be severe.

The rise and decline of nonsteroidal antiinflammatory drug-associated gastropathy in rheumatoid arthritis

OBJECTIVE

Nonsteroidal antiinflammatory drug (NSAID)-associated gastropathy is a major cause of hospitalization and death. This study was undertaken to examine whether recent preventive approaches have been associated with a declining incidence of NSAID gastropathy, and, if so, what measures may have caused the decline.

METHODS

We studied 5,598 patients with rheumatoid arthritis (RA) over 31,262 patient-years at 8 sites. We obtained standardized longitudinal information on the patients that had been previously used to establish the incidence of NSAID gastropathy, and also information on patient risk factors and differences in toxicity between NSAIDs. Consecutive patients were followed up with biannual Health Assessment Questionnaires and medical record audits between 1981 and 2000. The major outcome measure was the annual rate of hospitalization involving bleeding, obstruction, or perforation of the gastrointestinal (GI) tract and related conditions.

RESULTS

Rates of GI-related hospitalizations rose from 0.6% in 1981 to 1.5% in 1992 (P < 0.001), and then declined to 0.5% in 2000 (P < 0.001). The fitted spline curve fit the data well (R2 = 0.70). The period of rise was mainly associated with increasing patient age and the GI risk propensity score. The period of decline was associated with lower doses of ibuprofen and aspirin, a decline in the use of "more toxic" NSAIDs from 52% to 42% of patients, a rise in the use of "safer" NSAIDs from 19% to 48% of patients, and increasing use of proton-pump inhibitors, but not with change in age, NSAID exposure, or GI risk propensity score.

CONCLUSION

The risk of serious NSAID gastropathy has declined by 67% in these cohorts since 1992. We estimate that 24% of this decline was the result of lower doses of NSAIDs, while 18% was associated with the use of proton-pump inhibitors and 14% with the use of less toxic NSAIDs. These declines in the incidence of NSAID gastropathy are likely to continue.

Relationships between lactational incidence of displaced abomasum and milk production traits in German Holstein cows

The objective of this study was to analyse the heritabilitiy of the lactational incidence of displaced abomasum (DA) and the relationships of DA with milk production traits in German Holstein cows. Data were recorded between February 1999 and January 2000 in cooperation with five veterinary practitioners. Their veterinary practices were located in the northern part of Lower Saxony. The investigation included 160 dairy farms under the official milk-recording scheme with 9,315 cows. The lactational incidence of the left abomasal displacement amounted to 1.21%, and of the right abomasal displacement to 0.41%, respectively. The linear heritability estimates for the lactational incidences of left and right DA were h(2) = 0.05 +/- 0.012 and h(2) = 0.004 +/- 0.005, respectively. Using the Dempster-Lerner-transformation the corresponding heritabilities were h(2) = 0.53 and 0.09, respectively. Milk losses for the lactation when DA was diagnosed were significant and reached 1016 kg milk, 41 kg fat, 36 kg protein and 0.07% protein. Fat content significantly increased by 0.18%. The analysis could not show significant differences between cows diagnosed with DA and cows not diagnosed with DA in the 305-day milk production traits of the lactation preceding the diagnosis of DA. There was also no indication for an unequal distribution of breeding values for milk performance traits between cows with and without DA. The additive genetic correlations between 305-day milk performance and left DA were low. The results indicated that cows with a high milk production and superior breeding values for milk performance were not exposed to an increased risk for DA.

Extended intestinal metaplasia. A survey of 1392 gastrectomies from dwellers of the Pacific basin

BACKGROUND

To assess the extent of gastric intestinal metaplasia (IM) in gastrectomy specimens in populations of the Pacific basin having different incidence of gastric carcinoma.

MATERIALS AND METHODS

One thousand three hundred and nine-two gastrectomies were investigated: 1088 had a gastric carcinoma and 304 miscellaneous gastric diseases. Twenty-one thousand three hundred and fourteen histological sections were reviewed under low-power (4X). IM was either spotty (SIM) or extended (EIM= encompassing one or more entire low-power fields/section). Widespread IM (WIM) was regarded as EIM if present in > or =5 histological sections.

RESULTS AND CONCLUSION

The percent of gastrectomies harboring a carcinoma increased significantly with increasing age more notably in those with diffuse carcinomas (DC) than in those with intestinal carcinomas (IC). The percent of gastrectomies with EIM was significantly higher in specimens with IC than with DC, particularly among elderly patients, and in specimens from countries with a high cancer incidence. The percent of gastrectomies with WIM was higher in specimens having IC than in those having DC. Migration per se did not influence the frequency of specimens with EIM in elderly Japanese patients: Japanese migrants to Hawaii had a similarly high frequency of EIM as those dwelling in Japan. Japanese patients with a gastric carcinoma showed atypical mitoses in areas with EIM far from the tumor, suggesting that cellular mutation(s) play a role in the evolution of EIM towards gastric dysplasia and carcinoma in that ethnic group. The drawback of gastric biopsies in assessing the extent of gastric intestinal metaplasia and, thereby, estimating possible cancer risk in long-term studies has been stressed.

[Genetic analysis of the prevalence of abomasal displacement and its relationship to milk output characteristics in German Holstein cows]

Genetic parameters for the prevalence of abomasal displacement and for milk yield traits were estimated using a data set of 3578 cows. The animals originated from 50 farms near Hanover being under the official milk recording scheme. At these farms all cases of abomasal displacement in German Holsteins were registered from July 2001 to January 2003. Using REML heritability estimates in linear animal models were h2 = 0.034 +/- 0.014, h2 = 0.017 +/- 0.013 and h2 = 0.029 +/- 0.011 for all cases of abomasal displacement, leftsided abomasal displacement and rightsided abomasal displacement, respectively. Additive genetic correlations between all cases of abomasal displacement and milk yield traits were small, ranging from rg = -0.20 (fat content) to rg = 0.08 (milk kg). However, there was a highly positive additive genetic correlation between leftsided abomasal displacement and milk yield of rg = 0.683 +/- 0.227. Leftsided abomasal displacement was correlated additive genetically to fat and protein yield, fat and protein content with rg = 0.595 +/- 0.297, r9 = 0.653 +/- 0.250, rg = -0.768 +/- 0.3280 und rg = -0.643 +/- 0.354, respectively. The additive genetic correlation to the ratio between fat and protein content was rg = -0.585 +/- 0.470. For rightsided abomasal displacement, additive genetic correlations were of similar size but with reversed signs. The estimates obtained for the residual correlations were negligibly small throughout.

Antimicrobial resistance incidence and risk factors among Helicobacter pylori-infected persons, United States

Helicobacter pylori is the primary cause of peptic ulcer disease and an etiologic agent in the development of gastric cancer. H. pylori infection is curable with regimens of multiple antimicrobial agents, and antimicrobial resistance is a leading cause of treatment failure. The Helicobacter pylori Antimicrobial Resistance Monitoring Program (HARP) is a prospective, multicenter U.S. network that tracks national incidence rates of H. pylori antimicrobial resistance. Of 347 clinical H. pylori isolates collected from December 1998 through 2002, 101 (29.1%) were resistant to one antimicrobial agent, and 17 (5%) were resistant to two or more antimicrobial agents. Eighty-seven (25.1%) isolates were resistant to metronidazole, 45 (12.9%) to clarithromycin, and 3 (0.9%) to amoxicillin. On multivariate analysis, black race was the only significant risk factor (p < 0.01, hazard ratio 2.04) for infection with a resistant H. pylori strain. Formulating pretreatment screening strategies or providing alternative therapeutic regimens for high-risk populations may be important for future clinical practice.

Clinical Paratuberculosis as a Cause for Higher Culling Rate in Cows with Left Displaced Abomasum and Diarrhoea in a Holstein Dairy Herd

The present report identifies a statistically significant (P < 0.001) higher postoperative culling rate in cows with left displaced abomasum (LDA) exhibiting diarrhoea, compared with cows with LDA and normal faeces from a large Holstein dairy herd (odds ratio = 34). Paratuberculosis was histopathologically confirmed in 77.0% of cows with LDA exhibiting diarrhoea.

Gastric prolapse through a gastrostomy tract

BACKGROUND/PURPOSE

Few reports have documented the incidence or the characteristics of children with gastric prolapse through a gastrostomy tract. The purpose of this report was to determine the incidence of gastric prolapse through a gastrostomy tract and to identify the salient features associated with gastric prolapse.

METHODS

This was a retrospective review of 1,042 children from The Children's Hospital, Denver, CO who had a gastrostomy constructed for enteral access between 1992 and 2002. The charts of children who had gastric prolapse through the gastrostomy tract were scrutinized to obtain a profile of the children who had prolapse, and 14 parameters were analyzed for correlation with the incidence of this complication.

RESULTS

Thirteen children had gastric prolapse through the gastrostomy tract for an incidence of gastric prolapse of 1.2%; 5 children had recurrent gastric prolapse through a gastrostomy tract for an incidence of recurrent gastric prolapse of 0.5%. Gastric prolapse occurred more often in children with ventilator dependence (31%), poor nutrition (54%), and neurologic disorders (58%). Gastrostomy devices with both ends fixed and rigid were associated with gastric prolapse (2.7%) more often than devices with only 1 end fixed and rigid (0.6%). Laparoscopic gastrostomy was associated with gastric prolapse and recurrent gastric prolapse more often than other gastrostomy construction techniques.

CONCLUSIONS

Children with poor nutrition, ventilator dependence, a neurologic disorder, a gastrostomy device with both ends fixed and rigid, and/or a laparoscopic gastrostomy, were prone to gastric prolapse.

Accelerated decline in Helicobacter pylori seroprevalence rate during the screen and treat project in Vammala, Finland, as demonstrated in 29- to 45-year-old pregnant women

The potential preventability of serious helicobacter-associated diseases - especially gastric cancer - has evoked interest in eradicating this pathogen from the population. We assessed the efficacy of the pioneering screen and treat intervention project in Vammala by studying helicobacter seroprevalence in pregnant women representing the normal population. Consecutive maternity clinic samples from native Finnish females at five different localities in 1995 (n=701) and 2000 (n=772) were investigated for class IgG H. pylori antibodies by enzyme immunoassay (Pyloriset EIA-G III, Orion Diagnostica, Espoo, Finland). In Vammala the change in helicobacter seroprevalence was -13%-units (between 1995 and 2000; p=0.0125, chi-square test) in > or =29-year-old females, +1.6%-units (difference statistically non-significant) in <29-year-old females, and -5.5%-units (difference statistically non-significant) in the whole study population. In the four reference localities studied, all the corresponding changes remained statistically non-significant. Thus, in Vammala the programme applied accelerated the decline of helicobacter infections in 29- to 45-year-old females and in 2000 the seroprevalence rate had also become significantly lower than that of the four reference communities combined (7.6% versus 13.5%, respectively, p=0.0433, chi-square test). The final outcome of the intervention project, i.e. the long-term effect of this decline on gastric cancer and peptic ulcer disease, remains to be evaluated.

Outbreak of gastric mucormycosis associated with the use of wooden tongue depressors in critically ill patients

OBJECTIVE

To describe a nosocomial outbreak of gastric mucormycosis caused by Rhizopus microsporus var. rhizopodiformis in five adult patients admitted to an intensive care unit (ICU).

DESIGN

Epidemiological surveillance study.

SETTING

A 12-bed polyvalent ICU of an acute care teaching hospital in Pamplona, Spain.

PATIENTS

Five patients admitted to the ICU requiring artificial ventilation, diagnosis on admission severe pneumonia in four patients and one polytrauma patient, within a 14-week period, were diagnosed with gastric mucormycosis based on microbiological and/or histopathological characteristics. Upper gastrointestinal bleeding was the presenting manifestation in 80% of patients.

INTERVENTIONS

Filamentous fungi isolated at the microbiology laboratory of the hospital were examined at the national Mycology Reference Laboratory in Madrid.

MEASUREMENTS AND RESULTS

Rhizopus microsporus var. rhizopodiformis growth was detected in gastric aspiration samples, environmental samples, wooden tongue depressors used to prepare oral medications (and given to patients through a nasogastric catheter), and in some tongue depressors stored in unopened boxes unexposed to the ICU environment. All depressors were purchased from the same supplier. R. microsporus was not isolated from batches purchased at different times from the same supplier and from another supplier. The outbreak terminated when contaminated tongue depressors were withdrawn from use.

CONCLUSIONS

Wooden tongue depressors contaminated by R. microsporus var. rhizopodiformis used to prepare oral medications caused an outbreak of fungal gastritis with an attributable mortality of 40%. Wooden material should not be used in the hospital setting.

Does the weather influence the occurrence of abomasal displacement in dairy cows?

Aim of the study was to investigate the correlation between the occurrence of abomasal displacement and the weather situations. Data were collected for the years 2000 and 2001 in the area around Lisbon at 26 farms keeping about 6500 Holstein-Friesian milk cows; the analysis of 372 cases of abomasal displacement were included in the study. The weather situation was assessed on daily basis: atmospheric pressure, relative humidity, precipitation, daily insolation, maximum air temperature, minimum air temperature and average wind velocity. These original parameters were modified for the statistical analyses according to atmospheric pressure, water vapour pressure, relative humidity, temperature, temperature range, precipitation, insolation and wind speed. The change of the weather situation was described by the mean absolute deviation (deviation of the meteorological parameters from the running mean over a period of 5 and 10 days) and by a method which was based on the principal component analysis of the entire data set. A weak influence of water vapour pressure, relative humidity, temperature, temperature range, precipitation, and insolation on the occurrence of abomasal displacements was found by linear correlation- and regression analysis. A higher probability for abomasal displacement was verified for low water vapour pressure, high relative humidity, low air temperature, low temperature range, high precipitation and low insolation. No statistically significant relations were found between occurrence of abomasal displacement and either wind velocity or atmospheric pressure. A time series analysis exhibited a higher prevalence for abomasal displacement for periods with a change from sunny, warm and dry days to cool, overcast and humid days. From the present work it can be concluded that the meteorological situation has an influence on the occurrence of abomasal displacement. Therefore, the weather situation should be included among the predisposing causes of the occurrence of abomasal displacements.

Influence of Transition Diets on Occurrence of Subclinical Laminitis in Holstein Dairy Cows

Pre- and postpartum diets varying in energy and fiber were studied for effects on subclinical laminitis in Holstein cows. Also, ruminal acidosis was examined relative to sole hemorrhages and ulcers. Cows (n = 98) were assigned to a 2 x 2 factorial arrangement of treatments in a randomized complete block. Diets high in net energy of lactation (NE(L)) and low fiber were classified as high NE(L), whereas low NE(L) and higher fiber were defined as low NE(L). Two diets were fed for 3 wk before calving and 2 others fed for 3 wk postpartum resulting in 4 treatment combinations: high NE(L), low NE(L); high NE(L), high NE(L); low NE(L), low NE(L); and low NE(L), high NE(L). Levels of NE(L) (Mcal/kg DM), percentage of acid detergent fiber, and percentage of neutral detergent fiber for low NE(L) vs. high NE(L) prepartum diets, were 1.51, 30.2, 47.2 vs. 1.65, 23.4, 39.8, respectively, and 1.70, 22.4, 36.8 vs. 1.77, 17.5, 31.4 for low NE(L) vs. high NE(L) lactating diets, respectively. A single diet was fed after 21 d in milk (DIM). Measures of hoof discoloration, hemorrhage, and/or ulcer formation were done at about 45 d before calving, and near 28 and 70 DIM. Rumenocentesis was performed 14 d before calving and at 8, 22, and 70 DIM. Hoof scores among treatments were similar at 28 DIM. The low NE(L), high NE(L) group had less desirable hoof scores than high NE(L), high NE(L), or low NE(L), low NE(L) groups from 55 to 75 DIM. Rumen pH did not differ by treatment before calving. The lowest postpartum rumen pH was significantly lower and rates of ruminal acidosis (pH < or = 5.8) at 8 and 22 DIM were higher for groups fed high NE(L) after calving. No direct relationship between low postpartum rumen pH and hoof scores on individual cows was found. Low NE(L) before calving and high NE(L) right after calving may increase risk of subclinical laminitis if not carefully managed.

Metaplasia intestinal especializada de esôfago distal na doença do refluxo gastroesofágico: prevalência e aspectos clínico-epidemiológicos

RACIONAL: A metaplasia intestinal especializada pode ser classificada, de acordo com os achados endoscópicos e histológicos, em Barrett longo, Barrett curto e metaplasia intestinal da cárdia. O esôfago de Barrett é doença adquirida que ocorre em aproximadamente 10% a 13% dos indivíduos com doença do refluxo gastroesofágico e representa uma condição pré-neoplásica. É caracterizado por substituição do epitélio escamoso estratificado pelo metaplásico colunar especializado, contendo células caliciformes. OBJETIVOS: Determinar, prospectivamente, a prevalência e as características clínico-epidemiológicas da metaplasia intestinal especializada de esôfago distal na doença do refluxo gastroesofágico. MÉTODOS: Entre abril e outubro de 2002, 402 pacientes com sintomas da doença do refluxo gastroesofágico foram avaliados através de questionário padronizado que abordava as variáveis demográficas e foram submetidos a exame endoscópico com biopsias 1 cm abaixo da junção escamocolunar, nos quatro quadrantes. RESULTADOS: Metaplasia intestinal especializada foi encontrada em 18,4% dos pacientes: 0,5% Barrett longo, 3,2% Barrett curto e 14,7% metaplasia intestinal da cárdia. Houve tendência de maior número de homens apresentando esôfago de Barrett e mulheres com metaplasia intestinal da cárdia. Todos com esôfago de Barrett eram da raça branca. Não houve relação entre a intensidade dos sintomas da doença do refluxo gastroesofágico e a presença de metaplasia intestinal especializada. O tempo de duração de sintomas superior a 5 anos foi uma tendência nos portadores de esôfago de Barrett. Este grupo também apresentou mais hérnia de hiato e esofagite mais intensa do que aqueles com metaplasia intestinal da cárdia. Não houve relação entre uso de tabaco ou álcool e metaplasia intestinal especializada. CONCLUSÕES: Esôfago de Barrett foi mais relacionado ao sexo masculino, com sintomas de longa cronicidade, esofagite mais intensa e sem associação com tabaco ou álcool.

[Factors influencing the diagnose on causes of dyspepsia in central area of Shaanxi province]

OBJECTIVE

To investigate the proportions of functional dyspepsia (FD) and structural diseases within the dyspeptic outpatients in hospitals of different ranking in central area Shaanxi province, and to explore the safety in adopting "symptom and treatment" algorithm used in Western countries.

METHODS

A clinical epidemiology survey was carried out by means of a stratified sample of 3 019 dyspeptic outpatients through standardized questionnaire. All of the patients were followed for 4 - 24 weeks, and finally received their diagnoses through a consistent criteria.

RESULTS

Proportionally, FD in all the outpatients took up 44.8% with 44.7% benign organic causes and 10.5% malignant diseases. In the patients who had marked alarm symptoms, the proportion of benign and malignant diseases rose to 52.1% and 29.2%, respectively. They were significantly higher than those without alarm symptoms (39.2%, 2.9%) (P < 0.01). All of the dyspeptic patients were divided into 7 groups according to different ages. 64.5% of FD patients were younger than 25 years and the rate of FD declined with age. It was found that only four patients below 35 years old had malignance. The number of cases increased significantly in age 35 - 45 group and reached 30.8% in 65 - 74 group.

CONCLUSION

There were some differences noticed within dyspeptic patterns between local area in China and Western countries, and the "symptom and treatment" approach was not entirely suitable to the local area in China.

Gastrointestinal cancer and herpes zoster in adults

BACKGROUND/AIMS

Herpes zoster is associated with immunosuppression, and also has an increased risk of malignancy. The aim of this study is to determine whether patients with Herpes zoster are at a higher risk of occult malignancy and gastrointestinal diseases.

METHODOLOGY

We examined 131 of 201 Japanese patients who showed evidence of Herpes zoster in the gastrointestinal tract including the large intestine using gastrointestinal endoscopy, total colonoscopy and CT scanning.

RESULTS

Six of 131 patients (4.6%) with Herpes zoster, who had undergone all three examinations, had malignancies. This rate is significantly higher than the predicted rate (P < 0.05). Five of six patients had gastrointestinal or colon cancer. Previously, 17 of the 201 patients has been surgically treated for cancers (17/201 = 8.5%, predictable rate = 8.9%), eleven of these 17 patients had surgery for gastric cancer, or for colon cancer etc. We also diagnosed three patients to have cancers after an episode of Herpes zoster, out of the 140 patients who we examined as study prospects (3/140 = 2.1%, relative risks = 1.75). No significant increases in the malignant rates were observed before or after the onset of Herpes zoster.

CONCLUSIONS

These findings are considered to support the policy to investigate patients with Herpes zoster for the presence of occult malignancies, though the rate of malignancy in such patients before or after episodes of Herpes zoster was not significantly different from that of the predictable rate.

Burden of Helicobacter pylori and H. pylori-related diseases in developed countries: recent developments and future implications

Helicobacter pylori colonizes the gastric mucosa. H. pylori infection is the main cause of peptic ulcer and gastric malignancy. This review gives an overview on the epidemiology of H. pylori infection and H. pylori-associated diseases in the developed world, mainly Europe, and it discusses very recent developments with regard to the prevalence and its future implications for H. pylori-associated diseases.

[Gastrointestinal anisakiasis. Study of a series of 25 patients]

INTRODUCTION

Infection with the parasite Anisakis simplex is common in Japan and northern European countries. The number of reported cases in Spain has increased since the first description in 1991. The aim of the present study was to evaluate the incidence, clinical patterns, histopathological lesions, treatment, and outcome of Anisakis simplex infection in our environment.

MATERIAL AND METHOD

Cases of gastrointestinal anisakiasis diagnosed in our center from December 1999 to January 2002 were studied. Only patients with detection of the parasite in oral endoscopy or the surgical specimen and those with elevated levels of specific IgE to Anisakis simplex, a clinical picture compatible with anisakiasis, or a history of raw fish intake were included. Epidemiological, clinical and laboratory data, as well as diagnostic, histopathologic and therapeutic features, and outcome in these patients were recorded.

RESULTS

Twenty-five cases of gastrointestinal anisakiasis were diagnosed during the study period, representing an incidence of 3.87 cases per 100 000 inhabitants/year. All the patients had ingested raw anchovies. Two groups were observed. The first group was composed of 10 patients with a gastric form of the infection, in which the main symptom was epigastralgia (90%). Oral endoscopy was performed in all patients and the parasite was detected in five (50%). The second group was composed of 15 patients with intestinal involvement in which the main manifestations were symptoms mimicking appendicitis (80%). The most frequent finding of laparotomy and/or imaging tests (abdominal ultrasonography, intestinal transit, abdominal CAT) was terminal ileitis (80%). Seven patients underwent surgery: intestinal resection was performed in four with detection of Anisakis simplex in three. Eosinophilic infiltration was found in all surgical specimens. Treatment was symptomatic in most of the patients and outcome was favorable in all.

CONCLUSIONS

Infection with Anisakis simplex should be investigated in patients with abdominal pain after intake of raw fish, ileitis of unclear origin, or eosinophilic gastroenteritis.

Portal hypertensive gastropathy and its interrelated factors

OBJECTIVE

To investigate the influences of helicobacter pylori (Hp) infection, liver function, gastroesophageal varicosity, esophageal varicosity ligation (EVL), and esophageal varicosity sclerotherapy (EVS) on patients with portal hypertensive gastropathy (PHG).

METHODS

Fourty-seven patients with liver cirrhosis included 34 patients with PHG and 13 patients without PHG. Liver function, Hp infection, and gastroesophageal varicosity were investigated clinically in all patients, and gastroscopy was made again in patients with EVL 1-2 months after operation to observe the changes of PHG.

RESULTS

The rate of Hp infection was lower in patients with liver cirrhosis than in controls. There was no relationship between Hp infection and PHG. The patients with gastroesophageal varicosity had a high incidence of PHG.

CONCLUSIONS

Despite no relationship between Hp infection and PHG, liver dysfunction can affect and promote PHG. Gastroesophageal varicosity may be closely related to PHG, but their degrees are not related. PHG can be caused or promoted by EVL.

Are dyspeptic symptoms linked to Helicobacter pylori? A prospective cohort study among medical students

OBJECTIVE AND DESIGN

In Austria, the prevalence of Helicobacter pylori (Hp) infection in healthy people with or without symptoms of dyspepsia has not yet been assessed systematically. We conducted a prospective cohort study among medical students during their rotation in internal medicine to determine whether or not dyspeptic symptoms are linked to Hp infection. Symptoms were assessed before testing for Hp so that knowledge of Hp status could not influence symptom-reporting behavior.

METHODS

From February 2000 to February 2001 we invited 242 medical students to participate in this trial. Abdominal symptoms were assessed by a questionnaire. Dyspeptic symptoms were defined according to the Rome II criteria: heartburn was not considered a dyspeptic symptom. Severity of symptoms was assessed using the Glasgow dyspepsia severity score (GDSS). After determination of symptoms, students underwent a 13C-urea breath test for Hp.

RESULTS

Of 242 students (103 male, 139 female, mean age 26 years, range 21-39 years), 23 tested positive for Hp (10%). Of 34 participants reporting dyspeptic symptoms (14%, GDSS-range 1-11), four were Hp positive (12%). Of the 208 asymptomatic students, 19 were Hp positive (9%). Statistical analysis did not show a significant difference in the frequency of Hp infection between asymptomatic students and students reporting dyspeptic symptoms.

CONCLUSION

Hp prevalence in Austrian medical students is similar to that in other western countries. There was no significant difference in Hp prevalence between dyspeptic students and asymptomatic students.

Gastrointestinal disturbances in diabetes

Gastrointestinal disorders are common in patients with diabetes mellitus. As many as 75% of patients visiting diabetes clinics will report significant gastrointestinal (GI) symptoms. The symptom complex experienced may vary widely. Many patients go undiagnosed and undertreated. Patients with a history of retinopathy, nephropathy, or neuropathy should be presumed to have GI abnormalities until proven otherwise. The workup should start with a thorough patient history and appropriate laboratory, radiographic, and GI testing. In addition to pharmacologic therapy, glycemic control and dietary manipulation play an important role in managing GI disorders in people with diabetes.

[Functional gastralgia]

Psychiatric and psychological examinations of 100 patients (80 females and 20 males) with functional gastralgia (ICD-10 diagnosis F45.31) have been conducted. In all the cases, the disease developed in chronic stress in persons with higher anxiety inclined to mild anxious and depressive reactions. Four stages of the disease development were described: reactive (neurotic) depression, psychosomatic reactions, psychosomatic cycles (mono- and polysystemic) and psychopathization. Development of psychosomatic personality was expressed as hypochondriac type.

Expansion of the Asiatic parasite Ashworthius sidemi (Nematoda, Trichostrongylidae) in wild ruminants in Polish territory

The abomasa of 40 wild ruminants (18 red deer, 9 roe deer, 13 European bison) shot in the Bieszczady Mountains and another 8 European bison shot in Bialowieza Primeval Forest, were examined for worms. Ashworthius sidemi was found in all of the animals from the Bieszczady Mountains, and the intensity of infection was usually massive. In Bialowieza Forest few specimens of A. sidemi were noted among three bison. Wild ruminants were infected by A. sidemi from June to September. The nematodes originating from this infection only attained sexual maturity in June of the following year, and from September the process of expelling the parasites of that generation began. From June to autumn, two generations of nematodes, one consisting of mature individuals from the previous year and the other of the current year comprising fourth stage larvae as well as juveniles, occur in these hosts. In the winter and spring periods until June, only one generation of the parasite, arrested fourth-stage larvae and juveniles, occurs in the hosts.