Asymptomatic chronic hyperamylasemia of unknown origin: an infrequent entity?

Benign pancreatic hyperenzymemia

Benign pancreatic hyperenzymemia is a newly identified syndrome characterized by an abnormal increase in serum pancreatic enzymes in the absence of pancreatic disease. The hyperenzymemia can occur sporadically or in a familial form, and all of the pancreatic enzymes show elevations. Although the condition is persistent, the enzyme elevations fluctuate considerably, even temporarily returning to normal levels at times. In this review the main characteristics of this syndrome are described.

Familial pancreatic hyperenzymemia

I recently described a new form of pancreatic hyperenzymemia in healthy subjects in the absence of any pancreatic disease. The aim of this study was to determine whether this pancreatic hyperenzymemia has a familial distribution. From January 1996 to January 1999, 25 subjects with chronic nonpathological pancreatic hyperenzymemia were seen, in 23 of whom it was possible to investigate family members. A total of 102 subjects was studied. In addition to clinical history, physical examination and routine blood analysis, serum amylase, pancreatic isoamylase, lipase, and amylasuria were determined. Abdominal ultrasonography was also performed. Seven of the 23 families studied were found to have more than one member with pancreatic hyperenzymemia. In all, 19 persons (eight female and 11 male) were found to have this trait (mean age, 32.7 years; range, 3-84). The increase in enzyme concentration over the upper normal limit was in the range of 1.3- to 5.2-fold for amylase, 1.4- to 8.6-fold for pancreatic isoamylase, and 1.6- to 18.0-fold for lipase. Amylasuria was also increased. Clinically, no subject had symptoms or signs of pancreatic or other disease. Abdominal ultrasonography was normal in all of them. The results of this study show that pancreatic hyperenzymemia in healthy subjects may present with a familial distribution. The underlying defect in this disorder is not known. Although it is a benign condition, awareness of it is important to avoid unnecessary concern, examinations, and expenditure.

Pretreatment antimicrobial susceptibilities of paired gastric Helicobacter pylori isolates: antrum versus corpus

BACKGROUND

Antimicrobial susceptibility testing of Helicobacter pylori isolates is the most useful tool for guiding specific therapy, especially when primary resistance is suspected. However, the most informative gastric biopsy site for detection of resistant H. pylori isolates is uncertain. We sought to determine whether susceptibilities to commonly used antimicrobials (amoxicillin, clarithromycin, minocycline, and metronidazole) were related to biopsy site.

METHODS

H. pylori isolates were obtained from patients who had duodenal ulcer and had not received any therapy directed against H. pylori. Agar-dilution minimum inhibitory concentrations of each antimicrobial were compared between paired H. pylori isolates from the antrum and the proximal corpus.

RESULTS

Differences in minimum inhibitory concentrations exceeding twofold were observed within the pairs of H. pylori isolates in 5 of the 40 patients tested. In three patients with clarithromycin-resistant isolates and two with metronidazole-resistant isolates, both antral and corporeal specimens revealed resistance. However, no patient had pairs of isolates categorized as resistant at one site and sensitive at the other.

CONCLUSIONS

While we found that an individual may have a mixed H. pylori infection with respect to differing antimicrobial susceptibility in different parts of the stomach, a single biopsy specimen from either the antrum or the corpus should provide reliable detection of H. pylori isolates with primary resistance.

Peripheral urocortin delays gastric emptying: role of CRF receptor 2

Urocortin, a new mammalian member of the corticotropin-releasing factor (CRF) family has been proposed to be the endogenous ligand for CRF receptor 2 (CRF-R2). We studied the influence of intravenous urocortin on gastric emptying and the role of CRF-R2 in peptide action and postoperative gastric ileus in conscious rats. The intravenous doses of rat CRF and rat urocortin producing 50% inhibition of gastric emptying were 2.5 and 1.1 microgram/kg, respectively. At these intravenous doses, CRF and urocortin have their actions fully reversed by the CRF-R1/CRF-R2 antagonist astressin at antagonist/agonist ratios of 5:1 and 67:1, respectively. Astressin (12 microgram/kg iv) completely prevented abdominal surgery-induced 54% inhibition of gastric emptying 3 h after surgery while having no effect on basal gastric emptying. The selective nonpeptide CRF-R1 antagonists antalarmin (20 mg/kg ip) and NBI-27914 (400 microgram/kg iv) did not influence intravenous CRF-, urocortin- or surgery-induced gastric stasis. These results as well as earlier ones showing that alpha-helical CRF9-41 (a CRF-R2 more selective antagonist) partly prevented postoperative ileus indicate that peripheral CRF-R2 may be primarily involved in intravenous urocortin-, CRF-, and abdominal surgery-induced gastric stasis.

New options in Helicobacter pylori eradication: efficacy, resistance and synergy

The eradication of Helicobacter pylori has become the focus of much attention since the first attempts at developing effective therapies some 10 years ago. This review focuses on ranitidine bismuth citrate (RBC), the first new drug to be introduced for use in the eradication of H. pylori. RBC when combined with clarithromycin gives consistently high eradication rates (above 80% intention-to-treat assessment in double-blind, international studies) as a simple dual therapy for 14 days or when combined with two antibiotics as a triple therapy for 7 days. RBC enhances the in vitro killing of H. pylori by antibiotics, such as clarithromycin, metronidazole or tetracycline, in a synergistic manner. This effect is seen even when the H. pylori strains are 'resistant' to the antibiotics. Such a synergistic effect probably explains the increased efficacy of RBC-clarithromycin dual therapies compared with clarithromycin dosed with acid-suppressive agents such as H2-receptor antagonists or proton-pump inhibitors.