Acute gastroduodenal mucosal lesions in obstructive jaundice: an overview of clinical and pathogenic problems

Fourteen patients with obstructive jaundice were investigated. The mucous membrane [by fibrogastroduodenoscopy] of the stomach and the duodenum, the fasting gastric juice pH and level of serum gastrin [by radioimmunoassay method] were investigated. The study showed a high incidence [71.4%] of gastroduodenal mucosal changes; 57% had gastritis, 14% had duodenitis, mucosal hemorrhages were in 7%, and peptic ulceration of the stomach in 7%. However, 14% were symptomless. The level of fasting gastric juice pH was between 1-3 in this group. There were no any changes of stomach and duodenum in four patients, they had fasting gastric juice pH more than 3. Serum gastrin level, which is stimulated by gastric secretion, is high in 42.8% of patients and shows positive correlation [r = 0.639, p < 0.001] with the duration of the obstruction. Thus, patients with obstructive jaundice and with normal or increased acidity is the group of risk for acute lesions of mucous membrane of stomach and duodenum. This may be the result of preventing the flow of bile and the pancreatic juice into the intestine which plays a role in the pathogenesis of this defect. Particularly, this provokes the interaction in circuit of gastrointestinal hormones. These patients need early prophylaxis and treatment of these lesions

Glycoproteins in chronic liver disease

The levels of serum haptoglobin, haemopexin, alpha 1-antitrypsin [alpha 1-AT] and orosomucoid [alpha 1-acid glycoprotein] were examined in the sera of 95 patients with microscopically confirmed chronic liver disease of different types. Haptoglobin concentration was significantly reduced in bilharzial hepatic fibrosis [BHF], in chronic active hepatitis [CAH], in post necrotic cirrhosis and in cardiac cirrhosis, while it increased significantly in biliary cirrhosis. Haemopexin concentration was reduced significantly increase in biliary cirrhosis. Haemopexin concentration was reduced significant increase in biliary cirrhosis. Whereas, the mean value in other groups showed no differences. The serum level of alpha 1-AT showed a highly significant reduction in cardiac cirrhosis patients. Serum orosomucoid level showed significant reduction in both the BHF and post necrotic cirrhosis groups, whereas, biliary cirrhosis patients showed increasing tendency without significant difference. It is concluded that determination of different forms of glycoproteins in chronic liver disease may be a useful adjuvet in assessment of hepatic cell function and severity of the chronic liver disease

Leukocyte migration inhibition in agarose and parietal cell antibody in chronic gastritis

Forty-one patients with chronic gastritis without pernicious anaemia and 12 healthy persons with normal gastric mucosa were examined. Cell-mediated immunity [CMI] against gastric fundal and antral mucosal antigens was studied using the leucocyte migration inhibition agarose test [LMAT], and serum parietal cell antibodies [PCA] were examined by the indirect immunofluorescence method. The LMAT was positive in eight [19.5%] out of 41 patients with gastritis and in none of the healthy subjects. In all these cases migration inhibition appeared with antigen that corresponded to gastric lesion. PCA were present in 11 [26.8%] out of 41 patients with gastritis and in 2 [16.7%] out of 12 healthy persons. No significant relationship was found between the PCA and the result of LMAT. Thus, it is concluded that, there is an evidence that immunological factors may participate in the causation of non-specific chronic gastritis