Factors predisposing to peptic ulcer disease in asymptomatic cirrhotic patients.

BACKGROUND: There is a high prevalence of peptic ulcer in cirrhotic patients, but the pathogenesis of peptic ulcer in cirrhosis remains inconclusive. AIM: To investigate factors associated with peptic ulcer and to evaluate peptic ulcer prevalence in asymptomatic cirrhotic patients. METHODS: A total of 130 cirrhotics were recruited into the study for endoscopic screening. Data were collected and biochemical tests were done. Doppler ultrasound was used to assess the portal vein velocity and size. Patients underwent endoscopy for the presence of varices and peptic ulcer. Helicobacter pylori infection was confirmed by urease test, histology and 14C-urea breath test. Statistical analysis was performed. RESULTS: Peptic ulcer was detected in 50 (39%) cases. Between peptic ulcer and non-peptic ulcer groups, there were no significant differences in age, sex, alcoholic drinking, smoking, non-steroidal anti-inflammatory drug use, portal vein velocity and size, except for H. pylori infection (P = 0.006), serum albumin (P = 0.02) and Child-Pugh score (P = 0.03). By multivariate analysis, H. pylori infection (OR: 3.26; 95% CI: 1.49-7.13; P = 0.003), Child-Pugh classes B (OR: 2.48; 95% CI: 1.04-5.91; P = 0.04) and C (OR: 3.26; 95% CI: 1.2-8.81; P = 0.02) were independently associated with peptic ulcer. CONCLUSION: H. pylori infection and advanced cirrhosis are important factors associated with active peptic ulcer.

Low and high doses of rabeprazole vs. omeprazole for cure of Helicobacter pylori infection.

BACKGROUND: Low-dose rabeprazole-based triple therapy was effective for Helicobacter pylori eradication in a few Japanese studies. AIM: To compare the effectiveness of 1-week low-dose and high-dose rabeprazole-based triple therapy with those of omeprazole. METHODS: One hundred and sixty-two H. pylori-infected dyspeptic patients were randomized to receive twice daily for 1 week either rabeprazole 10 mg (R10), rabeprazole 20 mg (R20) or omeprazole 20 mg (O) in combination with amoxicillin 1,000 mg (A) and clarithromycin 500 mg (C). H. pylori status assessment was by the CLO test and histology at entry and by the 13C-urea breath test at 4-6 weeks after cessation of therapy. RESULTS: H. pylori eradication rates in intention-to-treat groups were 85%, 96% and 83% for R10AC, R20AC and OAC, respectively. Eradication rates in per protocol groups were 86%, 96% and 90% for R10AC, R20AC and OAC, respectively. On an intention-to-treat analysis, the R20AC group had a significantly higher eradication rate than did R10AC or OAC (P < 0.05). However, the higher eradication rate with R20AC did not reach statistical significance in the per protocol analysis. Drug intolerance was found in three OAC patients. CONCLUSION: High-dose rabeprazole-based triple therapy is more effective than its low-dose equivalent or omeprazole in eradicating H. pylori infection.

Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population.

The purpose of this study was to clarify the relation between psychological and other risk factors, notably helicobacter pylori (H. pylori) infection, in contributing to the occurrence of peptic ulcer (PU) disease. A retrospective case-control study was conducted at Siriraj Hospital, Bangkok from March to December 2000. Seventy endoscopically diagnosed patients with new PU or peptic perforation were compared with 70 patients with other diseases as well as blood donors control matched for age and sex. Historical risk factors, H. pylori Immunoglobulin G antibody (H. pylori IgG Ab), stress (Perceived Stress Questionnaire) and hostility (MMPI Hostility Scale) were assessed. Data were analyzed using logistic regression analysis. The results showed that PU was associated with chronic stress (aOR 2.9, p = 0.01; 95% CI, 1.3-6.5) and family history of PU (aOR 2.4, p < 0.03; 95% CI, 1.1-5.1), with an interaction effect between stress and irregular mealtimes (aOR 4.8, p = 0.01; 95% CI, 1.3-16.9). The incidence rate of H. pylori infection in PU patients was similar to the control group (61.4% and 50.0%, respectively, OR 1.2). The authors conclude that stress and family history, not H. pylori infection, are important risk factors for PU in this population. This finding supports previous studies in Thailand, showing a high prevalence of H. pylori in the population but a low association with PU, in contrast to developed countries. It remains to be seen whether the impact of a family history is due to genetic factors or shared life-style patterns.

Laboratory proficiency testing of aflatoxins in corn and peanuts--a cooperative project between Thailand and the United States.

The objective of this project was to conduct an aflatoxin proficiency test program in government, academia, and industry laboratories in Thailand. Aflatoxin-free corn and peanuts and corn and peanuts naturally contaminated with aflatoxins diluted to approximately 25 micrograms/kg were analyzed. Homogeneity of prepared, naturally contaminated test samples was checked on multiple replicates. The test was conducted according to the ISO/IUPAC/AOAC INTERNATIONAL Harmonized Protocol with z scores indicating laboratory performance. The participants used 3 methods: enzyme-linked immunosorbent assay, thin-layer chromatography, and the minicolumn. Of 19 laboratories that reported results for aflatoxins in naturally contaminated corn, 13 (68%) performed satisfactorily, on the basis of the mean obtained by an expert laboratory, a calculated target value for standard deviation, and the z score. Of 21 laboratories that reported results for aflatoxins in naturally contaminated peanuts, 10 (48%) performed satisfactorily. For aflatoxin-free corn, 6 laboratories reported finding aflatoxins at > or = 10 ng/g, chiefly by the minicolumn method; for aflatoxin-free peanuts, 1 laboratory reported finding aflatoxins at > 10 ng/g. Subsequently, a workshop of lectures and laboratory sessions was conducted to improve performance. A new and simple successive outlier removal procedure applied to the same data removed the same laboratories as did the use of z scores.

Upper gastrointestinal endoscopy in children with recurrent abdominal pain.

Over a 3 year period from 1992 to 1995, 62 patients with recurrent abdominal pain (RAP) underwent upper gastrointestinal endoscopy showing normal findings in 30 patients (48.4%), gastroduodentis 17 (27.4%), H. pylori gastritis 11 (17.7%) and esophagitis 4 (6.5%). Duodenal or gastric ulcer was not found. This study demonstrated more evidence of increased prevalence of organic causes of RAP than previous reports. Duration of illness of more than one year and vomiting were more common in H. pylori gastritis. Other symptoms including diarrhea, constipation, nocturnal awakening and pain related to meals could not differentiate between organic and functional cause. Major cases of H. pylori gastritis and gastroduodenitis responded to triple drug therapy and H2 blockers respectively.

Helicobacter pylori infection in Thai children with recurrent abdominal pain.

Sixty-five children with recurrent abdominal pain underwent gastrointestional endoscopy which showed Hp gastritis without duodenal ulcer in 16.9 per cent of cases. The prevalences of infection in recurrent abdominal pain and asymptomatic children were not different. Either urease test or histological method was appropriate for diagnosis of this infection. Triple therapy including bismuth subcitrate, amoxicillin and metronidazole improved abdominal pain symptom in 72.7 per cent without any side effect.

Isolectins from seeds of Artocarpus lakoocha.

Two isolectins (ALA-I and ALA-II), were isolated from seed extracts of Artocarpus lakoocha by anion exchange chromatography on Q-Sepharose fast flow columns at pH 8.5 and 8.0 ALA-I was unbound to the column at pH 8.5 and moved towards the cathode in non-denaturing polyacrylamide gel electrophoresis, whereas ALA-II possessed opposite properties. The two A. lakoocha agglutinins appeared to be composed of two dissimilar subunits (alpha and beta of M(r) 14,000 and 17,200) bound non-covalently. The isolectins possessed several similar properties including: blood type agglutination; pH optimum; pH and temp stability; as well as binding specificity towards asialomucins.

Helicobacter pylori: a comparison of CLO test and Giemsa's stain with culture in dyspeptic patients.

The prevalence of H.pylori in Thailand is high compared with Western countries and is the same as in China. We suggest either rapid urease test (CLO test) or Giemsa stain to be a rapid, reliable and convenient detection method for H.pylori and is also suitable for use in follow-up studies by gastroenterologists.

Helicobacter pylori and peptic ulcer diseases: prevalence and association with antral gastritis in 210 patients.

Evidence is accumulating that Helicobacter pylori infection plays a major contributory role in peptic ulcer disease [Duodenal Ulcer (DU) and Gastric ulcer (GU)] and non-ulcer dyspepsia (NUD). We, therefore, studied prospectively 210 consecutive patients with upper gastrointestinal symptoms (62 DU, 38 GU and 110 NUD) to determine the prevalence of H. pylori infection and to investigate their association with histological gastritis. Using endoscopic biopsy of the gastric antrum for diagnosing H. pylori infection by Campylobacter-like Organism (CLO) test, histology or bacteriology, the overall prevalence of H. pylori was 63.3 per cent. When H. pylori infection was related to diagnosis, DU had the highest prevalence rate of H. pylori infection (66%), GU and NUD were less frequently associated with H. pylori infection (55% and 44% respectively). We found a close association between H. pylori infection and histologically antral gastritis, in that 72.7, 61.7, and 62.6 per cent of the DU, GU and NUD patients with antral gastritis (respectively) had H. pylori infection. In contrast, none of these patients seen with normal antrum had H. pylori infection. We also found that the prevalence of H. pylori in our patient series was not age related. Of the three procedures used to demonstrate H. pylori, the CLO test and histological staining method gave the highest yields of 84.9 and 79.6 per cent respectively, and bacteriology in only 44.3 per cent, we conclude that the prevalence of H. pylori infection in Thai patients with upper gastrointestinal symptoms is high. H. pylori infection commonly occurs in the patients with antral gastritis, suggesting a possible etiologic role for the bacterium in the histologic lesion.

The movement of solutes and cells across tight junctions.

The TJ is a highly dynamic rate-limiting barrier for passive transepithelial solute flow. It is not only physiologically regulated but is modulated in various disease states as well. Such modulations occur as a result of epithelial cell interactions with immune cells or immune cell products and thus epithelial barrier function appears to be regulated in disease states.

An oligopeptide permeates intestinal tight junctions at glucose-elicited dilatations. Implications for oligopeptide absorption.

Turnover of the Na(+)-glucose cotransporter in the apical membrane of intestinal absorptive cells elicits alterations in tight-junction structure including the appearance of intrajunctional dilatations. Paralleling these structural responses, epithelial permeability to ions and nutrient-sized solutes increases. However, it is not known how these observed permeability changes specifically relate to the structural alterations elicited by glucose. Using a hemeconjugated peptide tracer (MP-11; mol wt, approximately 1900), the present study shows that the glucose-elicited tight-junction dilatations are specific anatomical sites of junctional permeation. This peptide tracer penetrates tight junctions selectively at sites of dilatations and is detected focally within the paracellular space. This same tracer does not penetrate junctions when glucose is not present. A heme-conjugated macromolecule (horseradish peroxidase; mol wt, approximately 40,000) is excluded by both glucose-exposed and glucose-unexposed tissues. The results of this study show a paracellular pathway for small peptides that is regulated during Na(+)-glucose-activated absorption. It is speculated that the paracellular pathway may contribute to the meal-related oligopeptide absorption that is known to occur and has previously been wholly attributed to the transcellular route.

Structure and function of the intestinal epithelial barrier in health and disease.

The major and rate-limiting barrier to transepithelial permeation in the intestine is the intercellular tight junction. Tight junction structure is often cell type specific and general but imperfect correlates between tight junction structure and permeability exist. The structure and permeability of this key barrier is not static and can be regulated physiologically. The means of regulation appears to involve the cytoskeleton of neighboring epithelial cells (particularly absorptive cells). Meal-related solutes--nutrients such as glucose--can reversibly enhance the permeability of absorptive cell tight junctions. Although this may substantially enhance the ability of the small intestine to harvest meal-related nutrients, it is conceivable that this may also result in transient exposure of the subepithelial compartment to potentially noxious lumenal compounds. Some features found in many intestinal disease states such as PMN migration across the epithelium may also result in transient barrier defects. With PMN transmigration it is clear that even macromolecules may permeate junctions being impaled by PMNs. When disease processes finally result in focal epithelial denudation, the epithelium has the potential of resealing such defects with remarkable efficiency. The preceding discussion highlights how dynamic the tight junction is and sets the stage for future work aimed at understanding the initial signaling events and intracellular cascade(s) that allow this major barrier to demonstrate such plasticity.

Effects of phlorizin and sodium on glucose-elicited alterations of cell junctions in intestinal epithelia.

Glucose alters absorptive cell tight junction structure and, as deduced from an impedance analysis model, diminishes tight junction resistance in the small intestine (J.R. Pappenheimer, J. Membr. Biol. 100: 137-148, 1987; and J.L. Madara and J.R. Pappenheimer, J. Membr. Biol. 100: 149-164, 1987). Here we provide further evidence in support of this hypothesis using the conventional approach of analysis of mucosal sheets mounted in Ussing chambers. This approach offers advantages for investigating underlying mechanisms, including the effects of ions and inhibitors on the regulation of intercellular junctions by glucose. We show that phlorizin blocks a resistance decrease elicited by glucose and demonstrate that substitution of choline for sodium also prevents the response. The dilatations in absorptive cell tight junctions that accompany this glucose-elicited response are similarly prevented by phlorizin exposure or sodium substitution. The effects of phlorizin on junctional permeability can also be demonstrated in vivo. Phlorizin reduces the transjunctional flux of creatinine in glucose-perfused intestines of anesthetized animals, even when account is taken of the reduction of fluid absorption caused by phlorizin. Last, in vivo perfusion studies suggest that although, at 25 mM luminal glucose, virtually all glucose absorption is transcellular, at a luminal glucose concentration of 125 mM approximately 30% of glucose absorption occurs paracellularly because of solvent drag across tight junctions of altered permeability.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute systemic melioidosis: an autopsy study of six cases.

Autopsy findings of six cases of the acute systemic melioidosis from Siriraj Hospital, Bangkok, Thailand during the years 1977 to 1986 are presented. Five out of six cases had some underlying conditions. Multiple abscesses and multiple organs involvement were the rule. The organs most commonly involved were lung and liver. Three patients had pericardial and one had adrenal gland involvement. Other significant pathological findings were fibrin thrombi (5/6 cases), haemorrhage (6/6 cases), tissue necrosis (4/6 cases) and granular casts in renal tubules (1/6 case). Abscess alone cannot explain the death of patients. Toxaemia, both exotoxins and endotoxin, is the most likely explanation from the death of patients.