Duodenal pathologies in children: a single-center experience / Patologias duodenais em crianças: experiência de único centro

Abstract Objective Several studies have been performed concerning pathologies of the stomach and esophagus in the pediatric age group. However, there have been very few studies of duodenal pathologies in children. The authors aimed to examine the clinical, endoscopic, and histopathological characteristics, as well as the etiology of duodenal pathologies in children. Method Patients aged between 1 and 17 years undergoing esophagogastroduodenoscopy during two years at this unit, were investigated retrospectively. Demographic, clinical, endoscopic data, and the presence of duodenal pathologies, gastritis, and esophagitis were recorded in all of the children. Results Out of 747 children who underwent endoscopy, duodenal pathology was observed in 226 (30.3%) patients. Pathology was also present in the esophagus in 31.6% of patients and in the stomach in 58.4%. The level of chronic diarrhea was higher in patients with duodenal pathology when compared with those without duodenal pathology (p = 0.002, OR: 3.91, 95% CI: 1.59-9.57). Helicobacter pylori infection was more common in patients with pathology in the duodenum (59.3%). Conclusion Duodenal pathology was detected in 30.3% of the present patients. A significantly higher level of chronic diarrhea was observed in subjects with duodenal pathologies compared to those with no such pathology. The rate of Helicobacter pylori infection was considerably higher than that in previous studies. In addition, there is a weak correlation between endoscopic appearance and histology of duodenitis.

Resumo Objetivo Foram feitos vários estudos com relação a patologias do estômago e esôfago na faixa etária pediátrica. Contudo, poucos estudos das patologias duodenais em crianças. Visamos a examinar as características clínicas, endoscópicas e histopatológicas, juntamente com a etiologia, das patologias duodenais em crianças. Método Foram investigados retrospectivamente pacientes entre 1 e 17 anos submetidos a esofagogastroduodenoscopia durante dois anos em nossa unidade. Os dados demográficos, clínicos e endoscópicos e a presença de patologias duodenais, gastrite e esofagite foram registrados com relação a todas as crianças. Resultados Das 747 crianças submetidas a endoscopia, 226 (30,3%) apresentaram patologia duodenal. A patologia também esteve presente no esôfago de 31,6% dos pacientes e no estômago de 58,4%. O nível de diarreia crônica foi maior nos pacientes com patologia duodenal, em comparação com os pacientes sem patologia duodenal (p = 0,002, RC: 3,91, IC de 95%: 1,59-9,57). Infecção por Helicobacter pylori foi mais comum em pacientes com patologia no duodeno (59,3%). Conclusão Foi detectada patologia duodenal em 30,3% de nossos pacientes. Um nível significativamente maior de diarreia crônica foi observado em indivíduos com patologias duodenais, em comparação aos sem patologia. A infecção por Helicobacter pylori esteve presente consideravelmente maior do que em estudos anteriores. Além disso, há uma fraca correlação entre a imagem endoscópica e a histologia de duodenite.

[Discrimination of dominant H. pylori strains isolated from patients with different gastroduodenal pathologies by protein profiling]

It is not clear what factors determine divergent outcomes of infections caused by H. pylori. The aim of this study was to differentiate H. pylori strains isolated from the patients with different gastroduodenal pathologies by protein profiling. The protein profiles of different strains of H. pylori isolated from 3 groups of patients with ulcerative disease, nonulcerative gastritis and cancer disease were analyzed using 1D-SDS-PAGE. Based on the highly divergent protein patterns, the similarity of the strains inside each group was 75%, 76.47% and 78.57% for cancerous, ulcerative and no ulcerative groups respectively, while about 30.76% of the protein bands were common in all strains isolated from three groups of the patients. Some of the observed bands were significantly specific for each group. We speculated that some H. pylori strains might be more associated with a specific disease than others, leading to the clustering of some, but not all, strains within each disease group. This study showed that protein profile can be a criterion used for discriminating of dominant states in different gastric clinical states. Specific and dominant proteins of different strains isolated from three groups of patients under the study could be welcome candidates for further exploration to be used both for laboratory tests, which analyze disease-specific H. pylori strains, and for diagnosis of different diseases and outcomes associated with this widespread bacterium

Ureases display biological effects independent of enzymatic activity: Is there a connection to diseases caused by urease-producing bacteria?

Ureases are enzymes from plants, fungi and bacteria that catalyze the hydrolysis of urea to form ammonia and carbon dioxide. While fungal and plant ureases are homo-oligomers of 90-kDa subunits, bacterial ureases are multimers of two or three subunit complexes. We showed that some isoforms of jack bean urease, canatoxin and the classical urease, bind to glycoconjugates and induce platelet aggregation. Canatoxin also promotes release of histamine from mast cells, insulin from pancreatic cells and neurotransmitters from brain synaptosomes. In vivo it induces rat paw edema and neutrophil chemotaxis. These effects are independent of ureolytic activity and require activation of eicosanoid metabolism and calcium channels. Helicobacter pylori, a Gram-negative bacterium that colonizes the human stomach mucosa, causes gastric ulcers and cancer by a mechanism that is not understood. H. pylori produces factors that damage gastric epithelial cells, such as the vacuolating cytotoxin VacA, the cytotoxin-associated protein CagA, and a urease (up to 10 percent of bacterial protein) that neutralizes the acidic medium permitting its survival in the stomach. H. pylori whole cells or extracts of its water-soluble proteins promote inflammation, activate neutrophils and induce the release of cytokines. In this paper we review data from the literature suggesting that H. pylori urease displays many of the biological activities observed for jack bean ureases and show that bacterial ureases have a secretagogue effect modulated by eicosanoid metabolites through lipoxygenase pathways. These findings could be relevant to the elucidation of the role of urease in the pathogenesis of the gastrointestinal disease caused by H. pylori.

Estudio de la epidemiología de la infección por el helicabacter pylori en el Perú: 20 años después / Epidemiologic study of helicobacter pylori infection in Peru

Se presentan los resultados de nuestras investigaciones en el campo de la epidemiología de la infección por el H. pylori en el Perú durante las últimas dos décadas. La prevalencia de la infección por H. pylori en Lima está disminuyendo en personas de nivel socioeconómico medio y alto, manteniéndose estacionaria en la población de nivel socioeconómico bajo. Esta disminución se está evidenciando tanto en la población peruana como en la japonesa residente en esta ciudad, y está asociada a la disminución de las enfermedades vinculadas a esta bacteria: úlcera péptica y adenocarcinoma de estómago. La infección es ligeramente más frecuente en el sexo masculino y se adquire en edades tempranas de la vida, siendo probablemente el agua y la vía oral-fecal, las formas de transmisión más importantes. Hasta el momento en nuestro país no existe evidencia que permita afirmar la mayor predisposición de ciertas razas para adquirir la infección. No hay diferencias enla infección por el H. pylori entre las poblaciones de la costa, la sierra y la selva del Perú; siendo en la población de altura más frecuente la gastritis crónica atrófica secundaria a la infección por H. pylori que en la población a nivel del mar.

Aislamiento e identificación de campylobacter pyloric en muestras gastroduodenales / Isolation and identificati of campylobacter pylori in gastroduodenal samples

El campylobacter pylori, bacilo curvo gramnegativo asociado a enfermedades gastroduodenales, ha sido investigado en un grupo de pacientes de 17 a 86 años mediante prueba de ureasa, coloración de Gram y cultivo, de 71 biopsias de tejido gástrico o duodenal. El microorganismo fue identificado en 46 pacientes para el 64,7 por ciento . la prueba de Gram resultó muy específica(100 por ciento ) y sensible(75 por ciento ), no así la ureasa, la cual tuvo el 78 por ciento de especificidad y el 86 por ciento de sensibilidad. Lamayoría de los casos positivos coincidió con pacientes que sobrepasaban la tercera década de la vida. Con este trabajo, logramos montar una técnica útil y factible de realizar en el laboratorio de un hospital, además de abrir un campo de investigación sobre este nuevo microorganismo

Campylobacter pyloridis in gastroduodenal lesions in chronic renal failure

Upper gastrointestinal endoscopy was done to twenty patients with chronic renal failure and biopsy specimens were taken from the antral and duodenal mucosa. The results of those patients were compared to ten healthy individuals with dyspeptic symptoms and normal upper GIT endoscopy, Campylobacter pyloridis were isolated from the antral and duodenal spicemens by culture in six patients out of twenty [30%]. Campylobacter pyloridis were detected histopathologically by silver stain only in the antral spicemens in those six patients, this organism may be an important factor in the aetiology of gastroduodenal lesion in chronic renal failure