[Polymorphism of helicobacter pylori and the presence of genes babA2 and sabA and endoscopic and histopathological changes in patients infected with Heicobacter pylori]

The infection of Helicobacter pylori is the main reason of a duodenal and gastric ulcer disease. Among other virulence factors of Helicobacter pylori, there are outer membrane proteins (OMPs), such as babA2 and sabA.

THE AIM OF THE STUDY

An assessment of a relationship between the presence of genes babA2 and sabA and endoscopic and histopathologic changes during gastritis, duodenitis and an ulcer disease.

MATERIAL AND METHODS

We included 119 patients aged from 3 to 17 (average 13.6) with gastritis and duodenitis and the infection of Helicobacter pylori. The endoscopy was conducted with taking samples of the mucosa for the histopathologic and genetic examination. The degree of endoscopic and histopatologic changes were determined according to Sydney's classification. The patients were devided in the extra groups with a small level (without erosion) and with a large level (with erosion) of endoscopic changes. To identify the infection of Helicobacter pylori, the PCR technique was used and then the presence of the babA2 and sabA genes of Helicobacter pylori was verified. The genetic confirmation of Helicobacter pylori infection was obtained in 88 patients and material was directed to the further examination.

RESULTS

Not statistically significant differences were determined between endoscopic and histopathologic pictures and either the presence or absence of the genes babA2 and sabA.

CONCLUSION

The presence of the genes babA2 and sabA is not related with level of endoscopic and histopathologic changes in pediatrics patients.

[The prevalence of dupA (duodenal ulcer-promoting gene) of Helicobacter pylori in children and adolescents--own observation]

The strains of Helicobacter pylori are described by many common features which determine their virulence. The genes which are connected with much higher virulence of some strains are vacA, cagA, oipA, dupA. Duodenal Ulcer Promoting Gene--dupA is the new virulence factor coexisting with a duodenum ulcer. There is a rationale that shows a protective character of dupA with reference to a stomach cancer. The dupA gene probably causes increasingly higher releasing of pro-infectious IL-8 via stomach cells and it influences the production of IL-12 and other cytokines. The aim of the study was to determine the frequency of dupA gene's appearance in the Polish children's group and in the Polish teenagers' group infected with H. pylori. The research was also aimed to determine the coexistence of dupA gene and duodenum ulcer disease or erosion infection of duodenum's mucous membrane.

MATERIAL AND METHODS

The endoscopic examination of the upper part of digestive duct was performed in 119 qualified patients with dyspeptic symptoms and with suspicion of stomach and duodenum's mucous membrane infection. The segments were taken for histopathological identification of H. pylori and for genetic indicating via PCR method. To confirm the presence of H. pylori in the extract the amplification of DNA fragment sized 860 pz was used. The presence of dupA gene was detected by PCR reaction with using the starters which include the fragment of jhp0917-jhp0918 sequence in the plastic H. pylori's genome area. To confirm the infection the urea breathing test was taken.

RESULTS

88 patients confirm the infection of H. pylori. The presence of dupA gene was found in 20 patients--a group A (22.7%), whereas in 68 patients dupA gene was not found--a group B (77.2%). Pathological changes in duodenum was found in 20 patients infected with H. pylori (22.7%), included 4 patients in the group A (20%) and 16 in the group B (23.5%). There was an infection (swelling, redness, congestion) in duodenum was found in the group A in all cases and there was an erosion presented in 3 patients. In the group B in 2 patients the duodenum ulcer disease was diagnosed. The infectious changes in duodenum were found in 7 patients but they were not infected with H. pylori; 1 patient was diagnosed with the duodenum ulcer disease.

CONCLUSION

The presence of dupA gene in the Polish children population infected with H. pylori is quite frequent but there is no clinical correlation with the duodenum ulcer disease.

Screening for celiac disease in Poland

BACKGROUND

Epidemiologic studies of celiac disease in Poland have been performed only within selected regions of the country and involve mainly symptomatic patients or groups at risk. The aim of this study was to assess the prevalence of celiac disease among children in Poland.

MATERIAL/METHODS

Screening for the presence of antiendomysial antibodies IgA endomysium (EmA) and IgG EmA was performed in 3235 children born between 1994 and 1997 and living in Bydgoszcz. Small-bowel biopsy was proposed for patients with a positive IgA EmA and/or IgG EmA titer.

RESULTS

A positive IgA EmA and/or IgG EmA titer was found in 25 patients (0.8%). Histopathologic features of celiac disease (Marsh stage III-B or III-C) were found in small-bowel biopsy specimens from 7 children, normal histologic features were found in 4 children, and 14 children did not undergo small-bowel biopsy. Celiac disease occurred more frequently among girls than boys (P<0.0001) and showed an asymptomatic (2/7 children) or oligosymptomatic (5/7 children) course. The prevalence of histologically confirmed celiac disease was estimated at 1 in 404 children, but the prevalence of serologically identified celiac disease was 1 in 124 children.

CONCLUSIONS

The prevalence of celiac disease in a population of Polish children was slightly lower than that in other countries and showed an asymptomatic or oligosymptomatic course, despite findings of advanced histopathologic lesions in the small bowel.

[Genetic type of Helicobacter pylori and the efficacy of eradication therapy]

Helicobacter pylori is one of the most popular bacteria in the world. The H. pylori infection is an etiological factor of permanent changes in inflammatory of stomach mucous membrane, peptic ulcer of the stomach and duodenum disease and stomach cancer or mucosa associated lymphoid tissue from lymphoid tissue of mucous membrane. The strain bacteria which produce the protein CagA and cytotoxin VacA belong to the more pathogenic strains. The most successful method of treatment for H. pylori infection is an eradication of the bacteria.

THE AIM OF THE STUDY

Was an evaluation of the influence which H. pylori genetic type (type I: CagA-positive, CagA-negative, VacA-positive, VacA-negative) has on efficacy of eradication therapy.

MATERIAL AND METHODS

214 of patients over the third year of life with symptoms of dyspepsia, of the upper part of the gastrointestinal tract was performed and H. pylori infection was proved in histopathological or (and) urease test and urea breath test. H. pylori identification was performed using PCR method for biopsy specimens of the gastric mucosa, estimating genetic type of the bacteria (CagA-positive, CagA-negative, VacA-positive, VacA-negative). Triple-drug eradication therapy was introduced. The efficiency of this treatment was checked after 6 weeks with the breath test.

RESULTS

The H. pylori infection was found in 101 patients (47.2%), 33 patients were infected with the strain type I (32.7%) and 68 patients (67.3%) with the strain type II. After the treatment the eradication of the infection was found at 71 patients (70.3%), lack of efficacy in H. pylori infection treatment was found at 30 patients (29.7%). Considerably higher percentage of eradicative infection was shown in the group of patients infected with the type II of H. pylori (76.5% vs. 58.8%, p < 0.04).

CONCLUSIONS

The effectiveness of eradication can be influenced by the genetic type of H. pylori. The better effects of eradicative treatment can be expected if one is infected with the strains of smaller virulence.

[The analysis of usefulness different diagnostic methods in children and adolescents with Helicobacter pylori infection]

A diagnostics of Helicobacter pylori infection in children and adolescents in practice sometimes is still difficult. Qualification to the tests for detecting infection with invasive and noninvasive methods should start from diligent anamnesis.

THE AIM OF THE STUDY

Is to present the clinical course and results of diagnostic tests in children and adolescents with suspicion of Helicobacter pylori infection.

MATERIAL AND METHODS

One hundred patients aged between 18 months and 18 years who underwent endoscopy with gastric biopsies, histology, culture and 13carbon urea breath test. There were 36 boys and 64 girls in analysed group, 10% of them were preschool children, 42% school children and 48% teenagers older than 12 years

RESULTS

Patients were symptomatic and most frequent were dyspeptic symptoms (91%). A symptom duration time was varied from several days to several years. On the basis of endoscopy and histology gastritis and/or duodenitis were found in 92 patients, esophagitis and gastritis in 5 patients, duodenal ulcer in 2 patients, in 1 case gastric and duodenal mucosa was normal. Helicobacter pylori infection was histopathologically confirmed in 37 patients. In 15 cases Helicobacter pylori strains were isolated with full in vitro sensitivity to amoxicillin, claritromycin and metronidazol. Urea breath test was conducted in 85 analyzed patients and 51 of them had abnormal result.

CONCLUSIONS

In clinical picture of Helicobacter infection most frequent were dyspepstic symptoms and by endoscopy chronic gastritis and/or duodenitis were shown. Culture of Helicobacter pylori has a limited usefulness in practice especially in patients who underwent antibiotic/eradication therapy. The statistical significant concordance occurred between culture and noninvasive 13carbon urea breath test.

[Twenty-two months old girl with haemorrhagic gastritis as a complication after the nonsteroid anti-inflammatory drugs application--case report]

The aim of case report was to pay attention for possibility of side effects of nonsteroid anti-inflammatory drugs. Child of young and healthy parents was born after normal pregnancy, natural delivery. The disease started in two days before the admission, child had fever, cough and sneezing. Mother gave her two doses of ibuprofen. On the time of admission general state of patient was moderate; girl was apathic. In physical examination features of upper respiratory tract infection were shown. In the course of treatment antibiotic and symptomatic drugs including paracetamol (3x5 ml) were delivered. During the second day of treatment child had no appetite, started to vomit with fresh and haemolized blood. Parenteral hydratation was started. Emergency gastroscopy was done and features of haemorrhagic gastritis were shown. Anti-inflammatory drugs were no more used and delivery of omeprazole was started. Parenteral hydratation was continued. General state of patient was better. In the sixth day after bleeding child was excripted in good general state with order of use of omeprazole. Parents were informed about the restriction of anti-inflammatory drugs use. The aim of case report was to pay attention that haemorrhagic gastritis may be one of side effects of nonsteroid anti-inflammatory drugs used accordingly to actual standards.

[Use of transcutaneous electrogastrography in the diagnostics of digestive tract diseases]

Transcutaneous electrogastrography (EGG) is the only non-invasive method of gastric myoelectric activity assessment which allows to evaluate slow wave activity and peak potentials of gastric contractions. During single channel analysis dominant frequency of slow waves (DF) is assessed, dominant power (DP), difference of DF and DP before and after the meal, percentage of normo-, brady- and tachygastry, ratio of dominant postprandial activity to preprandial acivity (power ratio--PR) and dominant frequency instability coefficient--DFIC). Multichannel EGG let us to assess myoelectric activity of different parts of stomach during one analysis. Transcutaneous electogastrography allows only for indirect evaluation of motoric disorders and needs many more studies to more precise assessment of its clinical use in gastroenterological diagnostics.

[Gastric myoelectrical activity in children and youth with dyspeptic symptoms]

THE AIM

of the study was to analyze gastric myoelectrical activity in children and youth with dyspeptic symptoms.

MATERIAL AND METHODS

113 children and youth aged 4.5 to 18 years (mean age 13.4 years) with dyspeptic symptoms were enrolled into the study. They were divided into 4 groups: group I--30 patients--without gastrooesophageal acid reflux GER (-) and Helicobacter pylori infection Hp (-), group II--35 patients, GER (+) Hp (-); group III--20 patients, GER (-) Hp (+); group IV --28 patients, GER (+) Hp (+). Gastrooesophageal acid reflux was recognized using 24-hour pH-metry. Helicobacter pylori infection was diagnosed based on histopathological examination of gastric body and/or antrum specimens, urease test and (or) C13 urea breath test. Gastric myoelectrical activity was performed using multichannel electrogastrography (Medtronic POLYGRAM NETTM). Six EGG electrodes were fixed on the subject's abdomen in standard places. Fasting EGG was recorded for 30 minutes followed by one hour postprandial recording after an ingestion of standard meal. Variables assessed were: dominant frequency (DF), the power of the dominant frequency (DP), percentage of bradygastria, normal, tachygastria and arrhythmia frequency, dominant frequency instability coefficient (DFIC), dominant power instability coefficient (DPIC) recorded from each channel (C1, C2, C3, C4) and average percentage slow wave coupling (%SWC) among channels. Comparisons were performed using Kruskal-Wallis's test.

RESULTS

In comparison to group II GER (+) Hp (-) in group I GER (-) Hp (-) were recorded significantly higher percentage of bradygastria frequency in C1 and C2 (5% vs 2% and 4% vs. 1%) and postprandialy significantly higher percentage of arrhythmia in C4 (18% vs 13%). In comparison to group Ill GER (-) Hp (+) in group I GER (-) Hp (-) fasting were observed significantly lower dominant frequency (2.89 vs 3.07 cpm), higher percentage of tachygastria frequency in C1 (3% vs. 1%), lower percentage of arrhythmia frequency in C2 (20% vs 29%), higher DPIC in C4 (1.46 vs 1.27), higher average percentage %SWC 2-3 (70% vs 59%) and postprandialy lower DFIC in C4 (0.45 vs 0.54). In comparison to group IV GER (+) Hp (+) in group I GER (-) Hp (-) fasting were recorded lower percentage of arrhythmia frequency in C1 and C2 (18% vs 27% and 20% vs 30%) and postprandialy lower percentage of arrhythmia frequency in C2 (11% vs 17%) and lower DFIC in C2 (0.37 vs 0.48). In comparison to group Ill GER (-) Hp (+) in group II GER (+) Hp (-) fasting were observed significantly lower percentage of bradygastria frequency in C1 (2% vs 4%), higher DPIC in C2 (1.87 vs 1.28), higher average percentage %SWC 1-3 and 2-3 (71% vs 63% and 71% vs 59%) and postprandialy higher percentage of bradygastria frequency in C1 (5% vs 3%) and higher average percentage %SWC 3-4 (68% vs 58%). In comparison to group IV GER (+) Hp (+) in group II GER (+) Hp (-) fasting were recorded significantly higher percentage of normal frequency in C1 and C2 (76% vs 68% and 75% vs 67%) and higher average percentage %SWC 1-2 (77% vs 69%) and postprandialy significantly lower percentage of arrhythmia frequency in C1 (12% vs 18%). In comparison to group IV GER (+) Hp (+) in group Ill GER (-) Hp (+) fasting were observed significantly higher dominant frequency (3.07 vs. 2.87 cpm, p < or = 0.01) and lower percentage of tachygastria frequency in C1 (1% vs 2%) and postprandialy lower percentage of bradygastria frequency in C1 and C2 (3% vs 5% and 3% vs 5%) and lower DFIC in C2 (0.33 vs 0.48).

CONCLUSION

In dyspeptic children and youth Helicobacter pylori infection and/ or gastrooesophageal acid reflux have influence on the gastric myoelectrical activity EGG abnormalities in patients with these diseases are varied, mostly preprandialy and recorded from proximal part of the stomach.

[Role of procalcitonin concentration in clinical diagnosis]

Procalcytonin (PCT) is a prohormon of calcitonin. It is made in thyroid structures. Level of procalcitonin is related from actual calcium concentration in blood. It is shown that procalcitonin level increases in bacterial, fungus and parasite infections, in systematic inflammatory response syndrome (SIRS), burn and multiple organ dysfunction syndrome (MODS). We wanted to conclude the actual knowledge about the role of procalcitonin used in acute infection. Level of PCT is compatible with the etiology of infection. The procalcitonin is a fast infection marker with a longer semi-loose time than CRP. A mechanism of secretion of procalcitonin to blood circulation is still enigmatic. The determination method (immunoluminometric assay) is easy and inexpensive and results are credible and can be used to differentiating and moni-toring of disease.

CONCLUSIONS

It is possible that PCT could be an important marker in fast diagnosis and differentiating of bacterial infections, also could be used in treatment monitoring and prognosis.