Hydrochloric acid secretion capacity of the stomach as an inherited factor in the pathogenesis of duodenal ulcer

Prooxidant activity of norbixin in model of acute gastric ulcer induced by ethanol in rats

Free radicals and oxidative stress play a central role in gastric injuries caused by ethanol (EtOH). Antioxidant strategies to counteract EtOH toxicity are highly desirable. Norbixin (NBIX) is a carotenoid with antioxidant potential largely used in the food industry. This study evaluated the NBIX effects in a model of gastric ulcer induced by EtOH in rats. Male Wistar rats received NBIX doses of 0, 10, and 25 mg/kg by gavage 1 h after EtOH administration (0 or 75% solution, 1 mL/200 g of animal). The animals were euthanized 1 h after the NBIX administration, and their stomachs were removed for macroscopic and histopathological analyses, quantification of nonprotein sulfhydryl (NPSH) groups, lipid peroxidation (LPO) levels, and catalase (CAT) activity determination. NBIX increased LPO in gastric mucosa and caused CAT inhibition and NPSH depletion in EtOH-treated animals. Results showed that NBIX did not protect gastric tissue against EtOH damage, and this could be associated to a prooxidant effect.

Measurement of the intracellular ph in human stomach cells: a novel approach to evaluate the gastric acid secretory potential of coffee beverages

As the consumption of coffee beverages sometimes is reported to cause gastric irritation, for which an increased stomach acid secretion is one of the promoting factors, different processing technologies such as steam-treatment have been developed to reduce putative stomach irritating compounds. There is evidence-based data neither on the effect of detailed processing variations nor on individual coffee components affecting the proton secretory activity (PSA). This work aimed at developing a screening model suitable for investigating the effects of commercial coffee beverages and components thereof on human parietal cells. Human gastric cancer cells (HGT-1) were treated with reconstituted freeze-dried coffee beverages prepared from customary coffee products such as regular coffee (RC, n = 4), mild bean coffee (MBC, n = 5), stomach friendly coffee (SFC, n = 4), and SFC decaffeinated (SFCD, n = 3). PSA was analyzed by flow cytometry using the pH-sensitive dye SNARF-AM. Treatment of the cells with MBC did not result in a PSA different from RC treatment (p <or= 0.07), whereas cells treated with SFC (p <or= 0.04) or SFCD (p <or= 0.03) showed a significantly lower PSA than those treated with RC. Quantitative and principle component analysis of putative stomach irritating compounds revealed significantly reduced contents of (beta)N-alkanoyl-5-hydroxytryptamides, caffeine, N-methylpyridinium, and catechol in SFCD compared to RC. However, none of these compounds seem to act as the sole key bioactive reducing the PSA of SFCD, since their contents in MBC and SFC samples were not different from those in RC samples, although the PSA of these beverages was significantly lower than that of reconstituted freeze-dried RC beverage.

Epidemiology and genetics of peptic ulcer

At the turn of the century, duodenal ulcer rose from rarity to affect 10% of males in their life time, subsequently declining in some countries such as UK, levelling off in others such as Germany, and continuing to increase in still others such as Hong Kong. The annual incidence per 1000 population varies from about 1 in Japan to 1.5 in Norway, 1.8 in USA and 2.7 in Scotland, and the frequency also varies within many individual countries, such as Australia, China and India, and among races such as a higher prevalence among whites than blacks in USA and among Chinese than Javanese in Indonesia. Ulcer frequency is higher in winter months, and this appears universal, being true in cold as well as in warm countries. Most places report a rise of ulcer rates among the elderly in recent decades. The male to female ratio also varies geographically, for example from 1:1 in USA to 18:1 in India, and with time such as moving from 2:1 to 1:1 in the last two decades in USA, and the duodenal ulcer to gastric ulcer ratio varies widely from place to place, for example from 0.8 in Japan to 19:1 in Africa and 32:1 in India. Placebo healing rates also differ geographically, ranging from 5% in Philippines to 78% in Mexico. These epidemiological data can only be explained by the presence of multiple aetiological factors, including analgesics, society stress, cigarette smoking, Helicobacter pylori, dietary factors, and genetic factors. Three lines of evidence support a genetic role: family studies, twin studies and blood group studies. Family aggregation occurs more commonly in patients with early-onset (< 30 yr) of symptoms. Blood group O prevalence is more associated with late-onset of symptoms. Other genetic markers include nonsecretor status, HLA antigens, phenylthiocarbamide taste sensitivity, and alpha-1-antitrypsin. Genetic syndromes such as MEN I also support a genetic role and give insight into pathogenetic mechanisms. The best physiological marker is still hyperpepsinogenemia I, which is transmitted by autosomal dominance, despite recent report of lower serum pepsinogen 1 after healing of Helicobacter pylori associated gastritis.

Multiplicative effect of hyperpepsinogenemia I and non-secretor status on the risk of duodenal ulcer in siblings

In a search for genetic markers of duodenal ulcer, serum pepsinogen I level, ABO blood groups and secretor status were determined in 89 siblings of 34 duodenal ulcer families. Duodenal ulcer patients were likely either to have hyperpepsinogenemia I or to be non-secretors on a familial basis, but not to have an increased frequency of blood group O. The frequency of duodenal ulcer in the siblings was highest in hyperpepsinogenemia I/non-secretor and lowest in normopepsinogenemia I/secretor. Therefore, the influence of two genes, hyperpepsinogenemia I and non-secretor, on the risk of duodenal ulcer is multiplicative. These results provide evidence on the hypothesis of polygenic inheritance of duodenal ulcer.

Psychosocial causes of duodenal ulcer

The evidence that duodenal ulcer is a psychosomatic disorder is reviewed. A variety of both experimental stressors and differing states of emotional arousal (anxiety and anger in particular) are associated with increased acid and pepsin secretion. Furthermore, chronic life stressors predispose to duodenal ulcer, presumably by way of symptomatic anxiety or depression, while poor social support may comprise another risk factor. Subjects with high levels of trait anxiety or neuroticism are more prone to stress-induced anxiety and its physiological consequences. There is minimal acceptable evidence to support more specific personality-related theories, including Type A behaviour, alexithymia or the earlier psycho-analytic theories of Alexander. Nonetheless, it is concluded that Alexander's inclusion of duodenal ulcer as one of a handful of classic psychosomatic disorders has been confirmed. Since some 40% of duodenal ulcer patients relapse in the first year after medical treatment, there may be some role for psychological treatments (especially in the domain of stress/anxiety management) for those patients who relapse and have co-existing high state or trait anxiety or exposure to chronic stressors.

Early- and late-onset duodenal ulcers in Chinese and Scots

Two unselected series of 528 Chinese and 539 Scottish patients with duodenal ulcer were compared. In both races, early-onset patients (symptoms began before age 30 years) in contrast to late-onset patients (symptoms began after age 30 years) constituted significantly more males, more patients with positive familial dyspepsia, more acid hypersecretors, and more gastrointestinal bleeding, but, unlike late-onset patients, there was no significant blood group O predominance, and their females did not have an older onset age than males. Among early-onset patients, Scottish patients developed symptoms at a significantly later age and had significantly more acid hypersecretors than Chinese, whereas among late-onset patients the Scots had significantly more patients with positive familial dyspepsia, in whom the frequency of acid hypersecretion was increased. These findings indicate that (i) early and late-onset duodenal ulcers are distinct subgroups, with many features common to both Chinese and Scots despite different ethnic backgrounds, suggesting the occurrence of similar pathophysiological mechanisms in the two races, (ii) for early-onset disease, these mechanisms appear to operate sooner in the Chinese, (iii) in the Scottish patients, familial late-onset duodenal ulcers with acid hypersecretion form a substantial and distinct subgroup.

Duodenal ulcers: early and late onset

A hospital series of 1042 duodenal ulcer patients was examined to determine the relationship of the age of onset of ulcer dyspepsia with the blood group and with the family history of ulcer dyspepsia. It was found that those patients whose symptoms begin in the first two decades of life (early onset patients) contain a significantly larger proportion of group A, B, and AB subjects and a significantly stronger family history of dyspepsia than those whose symptoms begin from the fourth decade of life onwards (late onset patients), in whom blood group O prevails. The group O status is shown to be associated with a significant proneness to duodenal ulceration and a significant proneness to bleed, and in the late onset patients a significant proneness to bleed recurrently and severely. Bleeding is the predominent complication in the early onset patients. There is a significantly increased tendency for the late onset ulcers to perforate, to become stenosed, to have severe pain, and to be virulent--that is, to be multiple, post-bulbar, or giant. While these features do not appear to be related to the effect of ageing, the occurrence of associated gastric ulceration and the mortality rate was shown to be related.