The interleukin-1 RN polymorphism and Helicobacter pylori infection in the development of duodenal ulcer

BACKGROUND: The host genetic factors that determine the clinical outcomes for Helicobacter pylori-infected individuals remain unclear. AIMS: To elucidate the relations among interleukin-1 locus polymorphisms, and H. pylori infection in the development of duodenal ulcers. MATERIALS AND METHODS: In a case-control study involving 168 control subjects and 147 patients with duodenal ulcer, biallelic polymorphisms of two interleukin-1 loci, IL-1B(-511) and IL-1B(+3954), as well as the penta-allelic variable number of tandem repeats of interleukin-1 receptor antagonist IL-1RN, were genotyped, and the H. pylori states of controls and patients were examined. RESULTS: Helicobacter pylori infection, male gender and the carriage of IL-1RN*2 independently increased the risk of duodenal ulcer with odds ratios of 6.4 (95% confidence interval, 3.7-11.0), 1.9 (95% confidence interval, 1.1-3.4) and 2.7 (95% confidence interval, 1.1-6.8), respectively. Statistical analysis revealed an interaction between IL-1RN*2 and H. pylori infection with the duodenal ulcer risk conferred by the H. pylori infection substantially increased (odds ratios, 22.6; 95% confidence interval, 5.9-86.5) by the carriage of IL-1RN*2. In addition, a synergistic interaction between IL-1RN*2 and blood group O existed. The combined risk of H. pylori infection, the carriage of IL-1RN*2 and blood group O for duodenal ulcer was 27.5 (95% confidence interval, 3.1-243.6). CONCLUSIONS: This work is the first to verify IL-1RN*2 as an independent factor that governs the development of duodenal ulcers. Our data indicate that H. pylori infection and IL-1RN*2 synergistically determine susceptibility to duodenal ulcer. The blood group phenotype is possibly a crucial determinant for the outcome of the impact of an interleukin-1 locus polymorphism on H. pylori-infected individuals.     

Rank order of success favors longer duration of imidazole-based therapy for Helicobacter pylori in duodenal ulcer disease: a randomized pilot study

Background. Studies on eradication therapy in developing countries have shown a success rate of 70–85%, which is suboptimal. Duration of therapy may be an important factor dictating eradication success in such regions. Aim. The study was undertaken to evaluate the effect of increasing the treatment period on eradication of Helicobacter pylori in duodenal ulcer disease. Methods. A randomized trial was carried out in which 64 consecutive H. pylori‐infected patients with duodenal ulcer disease were enrolled. The patients were randomized to one of the three trial arms. Therapy consisted of lansoprazole 30 mg twice a day (b.i.d.), amoxycillin 1 g b.i.d. and tinidazole 500 mg b.i.d. The treatment period was 1 week in group I, 2 weeks in group II and 3 weeks in group III. At inclusion, patients underwent endoscopy and the presence of H. pylori was documented by a positive urease test and C14 urea breath test. Four weeks after completion of eradication therapy, the patients were subjected to repeat endoscopy to assess ulcer healing and tests for H. pylori infection. Results. Sixty‐four patients (55 male and nine female; mean age 35.5 years) were enrolled in each group. The H. pylori eradication rate for group I (1 week of therapy) was 47.6%, that for group II (2 weeks of therapy) was 80%, and that for group III (3 weeks of therapy) was 91.3% (p = .003). The ulcer healing rates were 71.4, 80 and 95.6% in groups I, II and III, respectively (p = .09). Conclusion. The 3‐week regimen significantly improved the eradication rate as compared with the 1‐week regime. Increasing the duration of therapy significantly improved the chances of eradication of H. pylori in duodenal ulcer disease.     

Assessing overmedication: biology,philosophy and common sense

Overmedication is nowadays a serious problem in health care due to influences from the pharmaceutical industry and agencies responsible for regulation. The situation has indeed become appalling in psychiatry, where both theories and treatments have deteriorated under the impact of the industry. The overmedication problem is associated with biased biology in medicine. Adequate biological approaches would indicate that drug therapies must yield to diet therapies, particularly treatments involving omega-3 fatty acids, in many cases. To the extent that philosophy of science adapts to mainstream medicine in analyses of the current situation, it may reinforce the existing bias. To redress imbalances in health care, we ultimately have to rely on common sense.     

Normalization of phospholipids concentration of the gastric mucosa was observed in patients with peptic ulcer after eradication of Helicobacter pylori

Background. Phospholipids concentration in the gastric mucosa decreased in patients with Helicobacter pylori infection. The aim of this study is to examine the effects of eradication of H. pylori on decreasing the phospholipids concentration in the gastric mucosa in patients with gastric or duodenal ulcer. Materials and Methods. Phospholipids (phosphatidylcholine, phosphatidylethanolamine, and sphingonomyeline) were measured in biopsy specimens from the antrum and corpus using thin‐layer chromatography. In H. pylori positive patients with gastric ulcer (n = 26) and duodenal ulcer (n = 13), and H. pylori negative controls (n = 20), the biopsy specimens were obtained before and 3 months after eradication. Eradication was performed using lansoprazole, amoxycillin, and clarithromycin. Results. Compared with the H. pylori negative control group, the concentrations of phosphatidylcholine and phosphatidylethanolamine decreased significantly in the gastric ulcer group in both antrum and corpus mucosa, and in the duodenal ulcer group in antrum mucosa. This decrease returned to the control level after eradication. Conclusions. This study demonstrates that the eradication of H. pylori in patients with peptic ulcer normalized the decrease of phosphatidylcholine and phosphatidylethanolamine in the gastric mucosa.     

Comparison of the antisecretory and antiulcer activity of epidermal growth factor,urogastrone and transforming growth factor alpha and its derivative in rodents in vivo

This study investigates the effects of epidermal growth factor (EGF), urogastrone (UG) and transforming growth factor-alpha (TGF) and its derivative on dimaprit- and pentagastrin-induced gastric acid secretion and on acidified ethanol (AE)-evoked ulcer formation in anaesthetized rats. EGF, TGF and UG administered subcutaneously (s.c.) 30 min before dimaprit inhibited gastric acid secretion. Against pentagastrin-stimulated secretion, TGF inhibited, while EGF and UG potentiated, acid secretion dose-dependently. Intraduodenal (i.d.) administration of TGF and UG had no effect, while EGF potentiated, both secretagogue-induced acid secretion in the same dosage schedule. Administration of either EGF, UG or TGF i.v. bolus, in response to continuous infusion of dimaprit resulted in a significant (p < 0.05–p < 0.001) inhibition of acid secretion which was transient and returned to normal within 30–45 min for UG while it slowly returned to normal for EGF and TGF. The truncated form of TGF (amino acids 34–43) did not show any antisecretory effect when administered parenterally. Acidified ethanol produced gastric haemorrhagic lesions in the rat 1 h after oral administration. The gastric mucosal protective effects of TGF, EGF and UG administered either orally or s.c. 30 min before the administration of AE were dose-dependent against this model of ulcer induction. Indomethacin (Indo), administered 15 min before AE to inhibit prostanoids biosynthesis, significantly (p < 0.001) reduced the cytoprotective effects of TGF, EGF and UG and aggravated the ulcer index when administered s.c. The results show that PGs may be involved in mediating the protective effects of the three growth factors. Administration of NG-nitro-L argininemethylester (L-NAME) 15 min prior to TGF, EGF and UG s.c. or orally, significantly (p < 0.001) decreased the degree of ulcer indices and was able to reduce the protective effects of TGF, EGF and UG, thus including the role of NO in mediating the protective effects of these growth factors. In conclusion, these results have demonstrated that EGF, UG and TGF have a short and reversible inhibitory effect on dimaprit-stimulated gastric acid secretion and each is effective parenterally but not orally. UG and EGF potentiated, while, TGF inhibited pentagastrin-stimulated acid secretion. In addition, TGF seems to lose its activity when it is truncated from the C terminus. The present study also suggests that EGF, UG and TGF are equally effective against AE-induced gastric ulcer and bring about their cytoprotective action through their reduction of acid secretion and through PG and NO pathways.     

A comparative study of three variations of the learning vector quantizer in the discrimination of benign from malignant gastric cells

A prospective study was undertaken to investigate the potential value of morphometry and artificial neural networks (ANN) for the discrimination of benign and malignant gastric lesions. Two thousand five hundred cells from 23 cases of cancer, 19 cases of gastritis and 58 cases of ulcer were selected as a training set, and an additional 8524 cells from an equal number of cases of cancer, gastritis and ulcer were used as a test set. Images of routine processed gastric smears stained by the Papanicolaou technique were processed by a custom image analysis system. The application of the learning vector quantization (LVQ) classifier enabled correct classification of > 97% of benign cells and > 95% of malignant cells, obtaining an overall accuracy of > 97%. This study presents the capabilities of ANN, and also indicates that ANN and image morphometry may offer useful information on the potential of malignancy in gastric cells.     

埃索美拉唑对糜烂性胃溃疡患者血清ERK1/2及EGFR水平的影响

目的:探讨埃索美拉唑对糜烂性胃溃疡患者血清ERK1/2及EGFR水平的影响及临床疗效。方法:收集我院糜烂性胃溃疡患者106例,随机分为实验组和对照组。对照组予以奥美拉唑治疗,实验组予以埃索美拉唑治疗。检测并比较两组患者治疗前后血清ERK1/2及EGFR水平变化,观察患者溃疡面积、愈合情况以及临床症状的改善情况等。结果:与治疗前比较,治疗后两组患者血清ERK1/2及EGFR水平上升,差异有统计学意义(P0.05);与对照组比较,实验组治疗后ERK1/2及EGFR水平较高,差异有统计学意义(P0.05)。与治疗前比较,治疗后两组患者溃疡面积均减小,差异有统计学意义(P0.05);与对照组比较,实验组治疗后溃疡愈合情况更显著,差异有统计学意义(P0.05)。与治疗前比较,治疗后两组患者临床症状均获得缓解,差异有统计学意义(P0.05);与对照组比较,实验组治疗后症状改善更明显,差异有统计学意义(P0.05)。结论:埃索美拉唑可调节糜烂性胃溃疡患者血清ERK1/2及EGFR水平,改善溃疡情况,缓解临床症状,提高临床疗效,值得临床推广应用。     

Involvement of prostaglandin E receptor EP3 subtype in duodenal bicarbonate secretion in rats

We investigated the involvement of prostaglandin E (PGE) receptor subtype EP3 in the regulatory mechanism of duodenal HCO₃⁻ secretion in rats. A proximal duodenal loop or a chambered stomach was perfused with saline, and HCO₃⁻ secretion was measured using a pH-stat method and by adding 2 mM HCl. Mucosal acidification was achieved through 10 min of exposure to 10 mM HCl in the duodenum or 100 mM HCl in the stomach. Various EP agonists or the EP4 antagonist were given i.v., while the EP1 or EP3 antagonist was given s.c. or i.d., respectively. Sulprostone (EP1/EP3 agonists) stimulated duodenal HCO₃⁻ secretion in a dose-dependent manner, and this response was inhibited by AE5-599 (EP3 antagonist) but not AE3-208 (EP4 antagonist). AE1-329 (EP4 agonist) also increased duodenal HCO₃⁻ secretion, and this action was inhibited by AE3-208 but not AE5-599. The response to PGE₂ or acidification in the duodenum was partially attenuated by AE5-599 or AE3-208 alone but completely abolished by the combined administration. Duodenal damage caused by mucosal perfusion with 150 mM HCl for 4 h was worsened by pretreatment with AE5-599 and AE3-208 as well as indomethacin and further aggravated by co-administration of these antagonists. Neither the EP3 nor EP4 antagonist had any effect on the gastric response induced by PGE₂ or acidification. These results clearly demonstrate the involvement of EP3 receptors, in addition to EP4 receptors, in the regulation of duodenal HCO₃⁻ secretion as well as the maintenance of the mucosal integrity of the duodenum against acid injury.     

激光佐治慢性皮肤溃疡疗效观察及诱导HSP70表达研究

目的:探讨激光治疗慢性皮肤溃疡的疗效及诱导创面组织热休克蛋白70(heat shock prote in 70,HSP70)表达情况。方法:将64例84处慢性皮肤溃疡创面随机分为传统治疗组和激光治疗组,激光治疗组在传统治疗基础上加用激光治疗,所有创面在治疗三周进行疗效判定;同期随机切取5例创面组织,并设正常皮肤为对照,行组织切片HSP70免疫组化染色,计数HSP70阳性细胞数并检测阳性细胞灰度值进行统计学分析;设计引物行RT-PCR检测HSP70mRNA表达情况。结果:两组慢性皮肤溃疡患者经相应治疗均较治疗前明显改善,但激光治疗组创面的治愈率和总有效率明显高于传统治疗组(P<0.05或P<0.01);免疫组化染色显示,正常皮肤和慢性溃疡组织中未见明显HSP70阳性表达细胞,激光治疗后三周后可见较多量的HSP70表达阳性细胞,其阳性细胞计数明显高于其它两组(P<0.01),细胞信号灰度表达明显低于其它两组(P<0.05),而传统治疗组与正常对照组无显著差异;RT-PCR结果发现激光治疗组组织中扩增到一条特异性泳带,大小约268 bp,正常皮肤和传统治疗组组织中未扩增到明显HSP70mRNA基因片段。结论:激光佐治慢性皮肤溃疡具有良好临床疗效,可能与激活创面细胞的热休克内源性保护机制而发挥抗感染和促进愈合作用有关。     

Results from the pediatric European register for treatment of Helicobacter pylori (PERTH)

BACKGROUND AND AIM: Data on the eradication treatment for childhood Helicobacter pylori are scanty. A register was established on the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) website to collect data on treatment performed by European pediatricians to ascertain what is practiced in the field. SUBJECTS: From January 2001 to December 2002, information on 597 children were entered by 23 European Centers, but only data of 518 treated children were completed and analyzed (86.7%, 262 male subjects, median age 9 years, range 1-14). According to their nationality, 226 children were from Southern Europe, 132 from Eastern Europe, 68 from Western Europe, and 4 from northern Europe, 68 from North Africa, and 20 from Asia. At endoscopy, 454 children had gastritis and 64 had ulcer (12.3%). Antibiotic sensitivity, tested in 361 cases, revealed 18% clarithromycin-resistant and 19% metronidazole-resistant H. pylori strains. RESULTS: Treatment was performed for 1 week in 388 and for 2 weeks in 130 children. Antibiotics were associated with proton pump inhibitors (PPI) in 345 and with bismuth in 121 children. Triple therapy was given to 485 children, dual therapy to 26, quadruple to 7. Follow-up data, by (13)C-Urea-Breath Test or histology or both, were available for 480 children. Overall eradication rate was 65.6%, significantly higher in children with ulcer (79.7%) than without (63.9%, p = .001). When given as first treatment, bismuth-containing triple therapies were more efficacious than PPI-containing ones (77% versus 64%, p = .02, OR 1.88, 95% CI 1.1-3.3). Twenty-seven different treatment regimens were used, but only six were administered to at least 18 children (range 18-157). There was no difference between treatments given for 1 or 2 weeks, or given as first or second therapies. CONCLUSION: European pediatricians entering data in the register used 27 different regimens. Bismuth-containing therapies resulted in higher eradication rate. Omeprazole-containing triple therapies were the most used although their efficacy was low. Therapies recommended for adults do not appear to be suitable for children.