Relationship between plasma cortisol levels and stress ulcer following acute and severe head injury

This study was designed to investigate the relationship between plasma cortisol levels and stress ulcer following acute severe head injury. The plasma cortisol levels were prospectively measured by radioimmunoassay in 68 patients following acute head injury. The diagnosis of stress ulcer was based on clinical evidence and was confirmed by endoscopic examination. Patients with stress ulcer and gastrointestinal bleeding [n = 30, 44.1%] were older than those without stress ulcer [38.2 +/- 7.9 vs. 28.3 +/- 9.7 years, P< 0.01]. The combined rate of poor recovery and death in the stress ulcer patients [70.0%] was significantly higher than in the nonulcer patients [42.1%, p = 0.02]. On each of the first 3 days following the head injury, the average plasma cortisol levels in the stress ulcer patients were higher than in the nonulcer patients [p< 0.01]. Univariate analysis showed a positive relationship between plasma cortisol on admission and stress ulcer [r= 0.329, p = 0.01]. Logistic regression analysis revealed that plasma cortisol levels on admission [OR = 2.326, 95% Cl = 1.982-2.466] and age [OR = 1.064, 95% Cl = 0.861-1.219] were independent predictors of stress ulcer. The data showed that acute severe head injury was associated with a significant increase in plasma cortisol. Plasma levels of cortisol and age were independent predictors of stress ulcer following acute head injury

ABO blood groups and Helicobacter pylori cagA infection: evidence of an association

Diseases resulting from Helicobacter pylori infection appear to be dependent on a host of genetic traits and virulence factors possessed by this microorganism. This paper aimed to investigate the association between the ABO histo-blood groups and H. pylori cagA infections. Genomic DNA samples (n = 110) of gastric biopsies obtained from patients with endoscopic diagnosis of peptic ulcers (n = 25) and chronic active gastritis (n = 85) were analyzed by PCR using specific primers for the cagA gene. Of the samples, 66.4 percent (n = 73) tested positive and 33.6 percent (n = 37) negative for the gene. The cagA strain was predominant in peptic ulcers (n = 21; 84.0 percent) compared with chronic active gastritis (n = 52; 61.2 percent) (p = 0.05; OR 3.332; 95 percent CI: 1.050-10.576). Additionally, the cagA strain was prevalent in the type O blood (48/63; 76.2 percent) compared with other ABO phenotypes (25/47; 53.2 percent) (p = 0.01; OR 2.816; 95 percent CI: 1.246-6.364). These results suggest that H. pylori cagA infection is associated with the O blood group in Brazilian patients suffering from chronic active gastritis and peptic ulcers.

Can anti-Helicobacter pylori and anti-CagA antibodies be used to select patients with dyspepsia for gastroscopy?

BACKGROUND: agA IgG antibody in sera may indicate presence of peptic ulcer disease among dyspeptic patients and therefore may be used as a serological marker to identify high risk patients for peptic ulcer who can be subjected to endoscopy. Present study was performed to identify association of CagA IgG antibody in patients with peptic ulcer. METHODS: Consecutive patients with dyspepsia were subjected to endoscopy and sera was collected from each. Rapid urease test in antral tissue collected from each patient by endoscopic biopsy was performed. Antral tissue was also examined histologically. IgG Antibody against H. Pylori and CagA IgG antibody was tested in each patients sera. RESULTS: Out of 82 patients with dyspepsia included in the study 28 had peptic ulcer. Of whom 26 were positive for anti IgG H. Pylori antibody. More than 80% patients with peptic ulcer patients had detectable anti Cag A antibody in contrast to 33% patients with non ulcer dyspepsia (P < 0.001). CONCLUSION: Anti-Cag A antibody may be used as a screening test in patients with dyspepsia to select high risk patients for peptic ulcer for upper gastrointestinal endoscopy.

Evaluation of Serum Interleukin-18 levels in Helicobacter Pylori-infected peptic ulcer patients and its Association with Bacterial CagA Virulence Factor

Helicobacter pylori infection is one of the most common gastrointestinal infections worldwide. Predominant T-helper 1 [Th1] responses with increased gamma interferon [IFN- gamma] levels have been proposed to play an important role in H. pylori-induced peptic ulcer. However, bacterial factors contributing to the initiation of Th1 polarization of H. pylori-specific immune responses have not been characterized. Comparing serum concentrations of IL-18 in H. pylori-infected peptic ulcer [PU] patients, H. pylori-infected asymptomatic [AS] carriers and healthy control group and its association with bacterial virulence factor CagA. Thirty H. pylori-infected PU patients [20 patients were positive for anti-CagA antibody and 10 patients were negative for anti-CagA antibody], 30 H. pylori-infected [AS] carriers [15 subjects with positive test for anti-CagA antibody and 15 subjects with negative test for anti-CagA antibody] and 20 healthy uninfected subjects were included in this study. Serum concentration of IL-18 was measured by ELISA method. The mean serum levels of IL-18 in PU patients [333.2 pg/ml +/- 158], was significantly higher than those found in AS [146.5 pg/ml +/- 90.1; P<0.001] and healthy control [82.2 pg/ml +/- 45.7; P<0.0001]. In both PU and AS groups, mean serum IL-18 levels in subjects with positive test for anti-CagA antibody were significantly higher than those observed in subjects with negative test for anti-CagA antibody. No significant difference was observed between serum IL-18 levels of healthy uninfected control and AS carriers with negative test for anti-CagA antibody. The results of the present study showed higher serum concentrations of IL-18 in peptic ulcer patients compared with H.Pylori carriers and healthy controls. This difference in cytokine levels may be explained by differential expression of H.Pylori CagA gene during the course of the infection

Efficacy of sonicated and acid-extractable antigens in the serodiagnosis of H. pylori infection in peptic ulcer patients.

Helicobacter pylori is implicated in causation of peptic ulcers and gastric cancer and plays a pivotal role in gastric pathophysiology. In the present study we evaluated the relative efficacy of sonicated and acid-extractable antigens in the serodiagnosis of H. pylori infection in peptic ulcer patients by ELISA. In the present study we evaluated the relative efficacy of sonicated and acid-extractable antigens in the serodiagnosis of H. pylori infection in peptic ulcer patients by ELISA. The two types of antigens mentioned above were prepared from H. pylori subcultures following appropriate procedures. Sera were collected from 13 subjects of whom eight were diagnosed to be suffering from duodenal ulcer (DU) and five from non-ulcer dyspepsia (NUD) and screened for the presence of anti H. pylori antibodies by ELISA. A case was considered seropositive, if the OD value was more than or equivalent to twice the mean OD value of blank. Analysis of our results showed that, with acid extractable antigen at a concentration of 2 mg/mL, 12 cases were seropositive. Contrastingly, with sonicated antigen, at a concentration of 2 mg/mL only eight cases were positive. It is concluded from this study, that the use of relatively purified antigens like acid extractable antigens enhances the sensitivity and specificity of this serodiagnostic test, indicative of its relatively higher efficacy over sonicated lysate containing multiple antigens.

Distribución de los grupos sanguineos ABO en los pacientes con úlcera péptica / ABO blood group distribution in patients with peptic ulcer disease

OBJETIVO: determinar la distribución de los grupos sanguineos ABO en los pacientes con úlcera péptica. METODOS: trabajo descriptivo y retrospectivo. Se revisaron historias clínicas de pacientes con diagnóstico endoscópico de úlcera péptica y tipificación del grupo sanguineo ABO entre junio de 1994 y noviembre de 1996. Se tomó como control los pacientes y donantes del banco de sangre atendidos entre julio y agosto de 1996. El método estadístico utilizado fue el chi-cuadrado. RESULTADOS: se estudiaron 100 pacientes. En el control, 73 por ciento tuvieron el grupo sanguíneo O, en los pacientes con úlcera péptica 78 por ciento. De los ulcerosos duodenales, 85 por ciento presentaron grupo sanguineo O y de éstos, los menores de 40 años, 94 por ciento tenía grupo O. CONCLUSIONES: 1. la distribución de grupos sanguíneos en los pacientes con úlcera péptica es similar al control; 2. la distribución de grupos ABO en pacientes con úlcera duodenal muestra una diferencia estadísticamente significativa respecto al control con predominio del grupo O, particularmente en los pacientes menores de 40 años.

Ulcera péptica gastroduodenal y altura / Peptic ulcers and high altitude

Se realiza el estudio de 763 pacientes con enfermedad ulcerosa péptica gastro-duodenal, en el Hospital Regional "Honorio Delgado" de Arequipa (2300 metros sobre el nivel del mar), comparando las características de los pacientes de la Costa y la Altura. Se concluye que los pacientes de Altura la enfermedad ulcerosa se presenta en edades más tempranas (tercera década); predomina la presentación clínica atípica; tiene una mayor incidencia de complicaciones (59 por ciento), básicamente hemorragia (53 por ciento); la localización gástrica es más frecuente (UD/UG=2.5/1; versus 5/1 en pacientes procedentes de la costa) y la mortalidad en ellos es más elevada (2.0 por ciento)

Patología gastroduodenal y su relación con los grupos sanguíneos / Gastroduodenal pathology and its relation with blood groups

Se analizó la relación de los grupos sanguíneos con la patología gastroduodenal en 276 enfermos operados por carcinoma gástrico y úlceras gástricas y duodenales con un grupo control de 200 colecistectomizados. Se llegó a la conclusión de una mayor incidencia de carcinoma gástrico en el grupo A y de úlcera duodenal en el grupo O2 no obteniéndose resultados concluyentes respecto a la úlcera gástrica