HEREDITARY ASPECTS OF DUODENAL ULCERATION: SERUM-PEPSINOGEN LEVEL IN RELATION TO ABO BLOOD GROUPS AND SALIVARY ABH SECRETOR STATUS

Gastroduodenal Ulcers and ABO Blood Group: the Japan Nurses' Health Study (JNHS)

Background

Although several studies have shown that blood type O is associated with increased risk of peptic ulcer, few studies have investigated these associations in Japan. We sought to investigate the association between the ABO blood group and risk of gastroduodenal ulcers (GDU) using combined analysis of both retrospective and prospective data from a large cohort study of Japanese women, the Japan Nurses’ Health Study (JNHS; n = 15,019).

Methods

The impact of the ABO blood group on GDU risk was examined using Cox regression analysis to estimate hazard ratios (HRs) and 95% confidence intervals (CI), with adjustment for potential confounders.

Results

Compared with women with non-O blood types (A, B, and AB), women with blood type O had a significantly increased risk of GDU from birth (multivariable-adjusted HR 1.18; 95% CI, 1.04–1.34). Moreover, the highest cumulative incidence of GDU was observed in women born pre-1956 with blood type O. In a subgroup analysis stratified by birth year (pre-1956 or post-1955), the multivariable-adjusted HR of women with blood type O was 1.22 (95% CI, 1.00–1.49) and 1.15 (95% CI, 0.98–1.35) in the pre-1956 and post-1955 groups, respectively.

Conclusion

In this large, combined, ambispective cohort study of Japanese women, older women with blood type O had a higher risk of developing GDU than those with other blood types.

Psychologic factors associated with peptic ulcer disease

Peptic ulcer disease provides an excellent model for the study of mind-body interactions in the pathogenesis and course of an illness. Early psychodynamic explanations of the role of personality factors in the evolution of peptic ulcer disease have been supplemented in recent years by more scientifically based studies on the role of stress and coping ability. Multiple psychosocial variables have confounded the outcome of many of these studies. Yet, a clear need and guidelines exist for the comprehensive medical and psychosocial evaluation and treatment of patients with peptic ulcer disease. Concomitant psychiatric assessment and management, including psychotherapeutic and psychopharmacologic approaches, for those patients with refractory symptoms or ongoing psychiatric symptoms carried out in close collaboration with primary caregivers will significantly decrease overall morbidity and mortality.

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.

Relations between serum pepsinogen levels, pepsinogen phenotypes, ABO blood groups, age and sex in blood donors

Serum pepsinogen A (pepsinogen I) levels and urinary pepsinogen A phenotypes were studied in relation to ABO blood group, age and sex in 700 healthy blood donors. There was no relation between urinary pepsinogen A phenotypes and serum pepsinogen A levels. It is concluded that serum PGA levels and PGA phenotypes are independent factors in predisposition to gastroduodenal disorders. Serum pepsinogen A levels were higher in males than in females and rose with increasing age. The ABO blood groups were not related to pepsinogen A phenotypes. Blood group O individuals showed higher serum pepsinogen A levels compared with blood group A. Pepsinogen A phenotypes with intensity of fraction 5 were more frequent in males compared with females.

Hereditary aspects of duodenal ulceration: pepsin 1 secretion in relation to ABO blood groups and ABH secretor status

Pepsin 1, the ulcer-associated pepsin, occurred significantly more frequently in the gastric juice of those patients with duodenal ulcer who did not secrete A, B, or H antigens into gastric juice than in those secreting these antigens. This observation may explain the increased proportion of such non-secretors among patients with duodenal ulceration. In patients with gastric ulcer and non-ulcer dyspepsia, and in a miscellaneous group of patients, there was no association of pepsin 1 secretion with secretor status, suggesting that the association noted in duodenal ulceration is an indirect rather than a direct one. No increase of pepsin 1 occurred in group O patients with peptic ulcer, so that the increased proportion of such patients in peptic ulcer does not arise from differences in pepsin 1 secretion.

ABH secretor status in patients with bladder tumours

The ABO blood groups and secretor status of a group of patients with bladder tumours were investigated and compared with those of a group of patients of a similar age suffering from a variety of genito-urinary diseases. Some of the control patients were known to have been exposed to potential carcinogens, and the findings in this group were analysed separately. No significant differences were found when comparisons of these three groups of patients were made.

Duodenal ulcer and recurrent dyspepsia

A survey of recurrent indigestion in four general practices (19,619 patients) showed a wide range of dyspeptic complaints. Of these 82 (4.2 per 1,000) already had a proved ulcer and 144 (7.3 per 1,000) had symptoms suggesting a duodenal ulcer and had either not been investigated or had previously had a normal barium meal. A duodenal ulcer was found radiologically in half the men (46 out of 95) but in only 16% of the women (8 out of 49). In 11 (25%) of the 46 men shown to have an ulcer a barium meal had been previously reported as normal. Evidence is put forward that ulcer symptoms in the large residue of patients with a normal barium meal (38 men, 29 women) were produced by a primary duodenal condition (duodenitis) of which ulcer was one complication.

Peptic ulcer in Central Scotland

This article concerns the social class incidence, duration of symptoms, age at onset of symptoms and the blood groups of patients who were found during 1962 at Stirling Royal Infirmary to have peptic ulcer. The ulcer was either proven radiologically or was found at laparotomy which was being carried out for perforation, severe haematemesis or some other reason.

A low incidence in males of both gastric and duodenal ulcers was found in Social Class 3 and an increase in incidence in Social Class 4. Gastric ulcer in males tends to occur later in life than duodenal ulcer and in females there is a striking increase in duodenal ulcer in the 40 to 49 decade of life. The hypothesis is advanced that this may be due to hormonal changes. A second hypothesis is advanced that ‘secretors’ of blood group genotype AA, BB, or AB are immune to duodenal ulcer.