Digestion

Ahmad, Mian Mashhud; Ahmed, Dewan Saifuddin; Rowshon, A.H.M.; Dhar, Swapan Chandra; Rahman, Motiur; Hasan, Mahmud; Beglinger, Christoph; Gyr, Niklaus; Khan, A.K. Azad

doi: 10.1159/000107046pmid: 17700024

Background and Aim: Bangladesh is a developing country with a very high prevalence of Helicobacter pylori infection, which has been ascribed to overcrowding and poor sanitary conditions. It has generally been accepted that the re-infection rate is higher in countries with a high prevalence of H. pylori infection. Short-term follow-up studies support this assumption but no long-term studies are available to confirm or refute this assertion. The present study was aimed to define the long-term H. pylori re-infection rate (6 years after successful eradication) in duodenal ulcer patients. Methods: In a previous study, 90 patients were successfully eradicated for H. pylori and followed-up for 24 months. 17/90 were found to be re-infected (18% re-infection rate per year in the first 12 months) [Gastroenterology 2001;792–798]. The remaining 73 patients were targeted for long-term follow-up. 26/73 were lost to follow-up; 6 symptomatic patients were tested H. pylori positive in the period between 24 and 60 months post-eradication. The remaining 41 patients were evaluated 72 months after successful eradication. The evaluation included clinical history taking, a ¹³C-urea breath test (UBT), and endoscopy. Results: Of the 41 H. pylori-eradicated patients analyzed after 72 months, 16 were H. pylori-positive. If the 6 patients, who were tested positive between 24 and 60 months, are added, the total re-infection cases amount to 22 subjects in the period between 24 and 72 months. Therefore, an overall annual re-infection rate 6 years after eradication of 5.02% can be calculated. Six of the 23 symptomatic patients had duodenal ulcer relapse, 5/6 were H. pylori re-infected and one was H. pylori-negative at 72 months post-treatment. Conclusion: The long-term annual H. pylori re-infection rate in Bangladeshi adults is markedly higher than in Western countries but lower than anticipated. In this study, duodenal ulcer relapse is clearly related to H. pylori re-infection.

Bektaş, Mehmet; Törüner, Murat; Çetinkaya, Hülya; Soykan, İrfan; Özden, Ali

doi: 10.1159/000106974pmid: 17687186

Sakai, Hitomi; Inamori, Masahiko; Iida, Hiroshi; Akimoto, Keiko; Endo, Hiroki; Nozaki, Yuichi; Akiyama, Tomoyuki; Sakamoto, Yasunari; Fujita, Koji; Takahashi, Hirokazu; Yoneda, Masato; Abe, Yasunobu; Kubota, Kensuke; Ueno, Norio; Kusakabe, Akihiko;

Sakai, Eiji; Takahashi, Hirokazu; Inamori, Masahiko; Endo, Hiroki; Akiyama, Tomoyuki; Akimoto, Keiko; Mawatari, Hironori; Nozaki, Yuichi; Fujita, Koji; Yoneda, Masato; Goto, Ayumu; Abe, Yasunobu; Kobayashi, Noritoshi; Kubota, Kensuke; Ueno, Norio; Nakajima, Atsushi

Endo, Hiroki; Inamori, Masahiko; Murakami, Takayuki; Yoshida, Kenichi; Higurashi, Takuma; Iida, Hiroshi; Takahashi, Hirokazu; Akiyama, Tomoyuki; Akimoto, Keiko; Sakamoto, Yasunari; Fujita, Koji; Yoneda, Masato; Abe, Yasunobu; Kobayashi, Noritoshi; Kubota, Kensuke;

Bardella, Maria Teresa; Elli, Luca; Velio, Pietro; Fredella, Clara; Prampolini, Luigia; Cesana, Bruno

doi: 10.1159/000107979pmid: 17848794

Background/Aims: Celiac disease is caused by environmental and genetic factors, and the relatives of celiac patients are at higher risk of developing celiac disease than the general population. This prospective study evaluates the prevalence of celiac disease in the asymptomatic siblings of celiac patients. Methods: Forty-eight siblings (22 males; mean age 13 years) of 39 celiac children (20 males; mean age 4 years), and 120 siblings (55 males; mean age 33 years) of 55 adult celiac patients (12 males; mean age 31 years) were serologically screened for celiac disease. Positive cases were considered for endoscopic duodenal biopsies. Results: Forty of the 168 asymptomatic siblings (23.8%) were affected by celiac disease. There were no differences between the index cases with and without affected siblings in terms of age at diagnosis, symptoms at onset, order of birth, associated disorders or other affected relatives. The male siblings of pediatric patients were affected in 40.9% of cases and female siblings in 26.9%; the corresponding figures for adults were 16.4 and 23.1%. Conclusions: Silent celiac disease is 24–48 times more frequent in the siblings of celiac patients than in the general population. No predictive factors for sibling involvement were found. Adult females seem to tolerate gluten less than adult males.

Kobata, Atsushi; Kotani, Tohru; Komatsu, Yoshino; Amagase, Kikuko; Kato, Shinichi; Takeuchi, Koji

doi: 10.1159/000108590pmid: 17878732

Aim: We investigated the roles of NO/NOS isoforms in the pathogenesis of ischemia/reperfusion (I/R)-induced gastric injury in mouse stomachs. Methods: Under urethane anesthesia, the celiac artery was clamped, and then reperfusion was established 30 min later by removal of the clamp. After a 60-min reperfusion, the stomach was examined for macroscopic lesions. Results: Following I/R, hemorrhagic lesions were generated in the mucosa, although ischemia alone caused no visible damage. Prior administration of L-NAME (a nonselective NOS inhibitor) significantly aggravated these lesions, in a L-arginine-inhibitable manner. By contrast, the selective iNOS inhibitor 1400W significantly prevented the occurrence of I/R-induced gastric lesions. The mucosal MPO activity was increased after I/R, and this response was enhanced and attenuated by prior administration of L-NAME and 1400W, respectively. Interestingly, the later treatment with L-NAME, given 10 min before reperfusion, significantly reduced the severity of the I/R-induced gastric damage, in a L-arginine-dependent manner. The expression of iNOS mRNA was up-regulated in the stomach following I/R, with an increase of mucosal NO content, and the NO production was significantly inhibited by both L-NAME and 1400W. Conclusion: Endogenous NO plays a dual role in the pathogenesis of IR-induced gastric damage; NO/cNOS is protective while NO/iNOS is proulcerogenic during I/R.

Sakai, Eiji; Inokuchi, Yasuhiro; Inamori, Masahiko; Uchiyama, Takashi; Iida, Hiroshi; Takahashi, Hirokazu; Akiyama, Tomoyuki; Akimoto, Keiko; Sakamoto, Yasunari; Fujita, Koji; Yoneda, Masato; Abe, Yasunobu; Kobayashi, Noritoshi; Kubota, Kensuke; Saito, Satoru; Nakajima, Atsushi

Zheng, Haoxuan; Wang, Jide; Sun, Yong; Jiang, Bo

doi: 10.1159/000108646pmid: 17893440

Objective: To carry out a preliminary epidemiological investigation of Yersinia enterocolitica from a clinical perspective in China and to further validate the consistency of real-time polymerase chain reaction (RT-PCR) and culture method. Methods: 700 stool samples were randomly and continuously collected from in- and outpatients with diarrhea, which were detected by both the culture method and RT-PCR. Results: All 52 positive samples were successfully detected by both RT-PCR and the culture method. The total incidence of yersiniosis was about 7.4%, which was statistically higher than before (0.65%) by the Mann-Whitney U test. The morbidity was not significant between males and females (U = 0.354, p > 0.05) by the Mann-Whitney U test whereas it was significant between children and adults (U = 2.06, p < 0.05) as well as between the autumn-winter and spring-summer (U = 2.04, p < 0.05) months. Moreover, the constituent ratio of children and adults with yersiniosis in different systems was not significant by the McNemer test while it was significant between children and adults in the incidence of extraintestinal infection (U = 2.51, p < 0.05). Conclusion: RT-PCR with better applicability will become an efficient tool for detection of virulent Y. enterocolitica and will also be used as an alternative to the culture method. Due to the higher incidence than before, we should publicize dietary hygiene and pay more attention to earlier diagnosis for yersiniosis and its complications, aiming at children <4 years and adults >60 years during the autumn-winter months.

Veenstra, R.P.; Geelkerken, R.H.; Verhorst, P.M.; Huisman, A.B.; Kolkman, J.J.

doi: 10.1159/000109373pmid: 17921672

We report a case of acute gastrointestinal ischemia during a very stressful event in whom the diagnosis was made by 24-hour tonometry. This case report unequivocally links a stressful event with increased catecholamine release and subsequent severe symptomatic gastrointestinal ischemia. The role of ischemia as potential pathophysiological mechanism has never been studied in detail. The clinical significance of finding such an association is underscored by this case report, where a vasoactive drug normally used for hypertension treatment resulted in greatly improved abdominal symptoms.