The role of Campylobacter (Helicobacter) pylori in disorders of the gastrointestinal tract.

To evaluate the role of Campylobacter pylori in different gastrointestinal disorders, serum IgG antibodies against C. pylori were determined in dyspeptic patients and in a control group of healthy children and adults. Twenty-eight percent of the dyspeptic patients with normal mucosa were seropositive. Among the patients with altered mucosa, the seroprevalence increased from duodenitis (48%) to gastritis (89%) and gastric or duodenal ulcer, gastric stump gastritis and carcinoma (100%, for each group, respectively). The C. pylori detection rate was lowest in patients with duodenitis alone (19%) and highest in patients with duodenal ulcers (95%). Therefore, C. pylori does not play an important role in patients with duodenitis alone. About 30% of patients with gastritis, active duodenal or gastric ulcer had antibody levels as low as the seroconverted dyspeptic patients but with normal gastroduodenal mucosa. C. pylori was not considered a causative factor for mucosal damage in these patients.

[Intragastric formation of ammonia in Campylobacter pylori associated gastritis. Diagnostic and pathogenetic significance]. / Intragastrale Ammoniakbildung bei Campylobacter-pylori-assoziierter Gastritis. Diagnostische und pathogenetische Bedeutung.

The diagnostic relevance of measurement of ammonia (NH3) in not stimulated gastric juice in patients with campylobacter pylori associated gastritis (CPAG) is in discussion. The role of CP-urease induced NH3 in pathogenesis of active gastritis is unclear. In answering to this questions we evaluated the sensitivity and specifity of NH3-test and CLO-test in cases of CPAG (n = 50), non CPAG (n = 16) and normal gastric mucosa (n = 20). We found a 88% sensitivity and a 86% specifity for NH3-test, a sensitivity for CLO-test of 80% and a specifity rate of 87%. NH3-test correlated well with CLO-test (n = 51, p less than 0.01) and semiquantitative histological identification of CP (p less than 0.01, n = 22). On the other hand we tried to correlate the amount of NH3 in the gastric juice and the histological degree of gastritis activity (infiltration of leucocytes of the lamia propria) in CPAG (n = 78) and Non-CPAG (n = 32) and before and after therapy in CPAG (n = 9) with bismuthsubnitrate (2 g/d, 14 d). There was no correlation between the amount of NH3 and the degree of active chronic gastritis in patients with CPAG (with or without therapy) and patients with non CPAG. It seems that NH3 has a diagnostic but no pathogenetic role in the process of inflammatory activity of CPAG.

[A rapid urease test in Campylobacter pylori colonization of the gastric mucosa]. / Urease-Schnelltestes bei Campylobacter-pylori-Besiedlung der Magenschleimhaut.

Biopsies from the gastric mucosa (antrum, corpus) of 145 patients investigated by endoscopy were analysed for Campylobacter pylori. The results of bacteriological, histological, enzymatic and chemical methods were compared. Urease activity was determined both in biopsies (CLO-test) and in gastric secretion. Furthermore, the concentration of urea was measured in gastric secretion. 71% of gastritis, 86% of ulcus duodeni and 83% of ulcus ventriculi diagnosed by endoscopy produced positive histological and/or cultural results, while 100% of control persons exhibited negative for both parameters. The sensitivity of the CLO-test (n = 112) was 95% and its specificity 78% when compared with bacteriological and histological results. The majority of false positive results was due to delayed and incomplete reactions. However, when compared with endoscopic-histological results the specificity of the CLO-test was 100%. The results of a modification of CLO-test (without culture medium) were up to 5 hours comparable. There was no positive correlation between the concentration of urea in gastric secretion and the histological or cultural identification of Campylobacter pylori. However, the measurement of ammonia turned out to be promising (sensitivity 80%). None of the tests was sufficiently specific on its own, whereas a 100% specificity was achieved when both the CLO-test and the determination of ammonia in gastric secretion were performed.

[Hydrogen (H2) exhalation tests--methods for general practice]. / Wasserstoff-(H2)-Exhalationstests--Methoden für die Praxis.

According to the literature as well as to own experience hydrogen breath tests seem to be suitable for a gastroenterologist's practice because of their practicability (this means non invasive and cheap methods) and their diagnostic relevance (sensitivity, specificity). Although hydrogen breath test with lactose is now the best way for diagnosis of lactose intolerance, hydrogen breath test with glucose as a mean of investigation of small bowel bacterial overgrowth still is subject to discussion. Lactulose hydrogen breath test in order to estimate small bowel transit time is of minor importance in gastroenterologist's practice. Yet at special questions it still may be of relevance (e.g. suspicion of functional diarrhea).

[Endoscopic intragastric detection of hydrogen]. / Endoskopischer intragastraler Wasserstoffnachweis.

The sensitivity of hydrogen (H2) breath-tests for testing small-intestinal bacterial overgrowth is limited by many factors. In this study H2 was tested directly with a selective electrochemical cell in a sample of stomach gas obtained during gastroscopy. This was possible in 100 of 109 cases. In patients with dyspeptic disorders (complaints of excess gas) H2 concentrations were significantly higher than in the group of patients without these complaints (p less than 0.001). In dyspepsia the stomach-test was significantly more often pathological than H2-breath-test with glucose (p = 0.01). There was no correlation between the results of both tests in 66 cases. Intragastral H2 may result from H2-reflux from the small bowel, because there was no difference in bacterial growth in gastric and duodenal juice and in gastric mucosa of patients with high and normal H2 concentrations in the stomach and because a motility disturbance of upper GI-tract (prolonged gastric emptying time) correlated well with H2-concentrations (p less than 0.05). PH of gastric contents, various ingested dietary substrates, smoking, endoscopic and histological diagnosis did not influence ig H2. Measurement of H2 during gastroscopy may give immediate evidence of small bowel motility-disorders.

[Improvement in the specificity of the PABA test (PFT) by combined PABA peptide/D-xylose administration and serum kinetic measurement?]. / Verbesserung der Spezifität des PABA-Tests (PFT) durch kombinierte PABA-Peptid/D-Xylose-Gabe und serumkinetische Messung?

To obtain higher specificity of peptide-PABA-test, an indirect pancreatic functions test, 150 mg N-BT-PABA together with 25 g D-Xylose in 300 ml tea were administered to a group of 68 persons. Maximal concentration of PABA and D-Xylose were investigated serum by time-concentration-curves 0, 60, 90, 120 and 150 min after test meal. Serum-PABA was found pathologically low in 18 of 20 patients with proofed chronic pancreatitis. In 16 of 17 patients with chronic pancreatitis serum-D-Xylose was normal. In a group of 39 patients, in which a pancreatic disease was excluded, PABA-serum-test showed no false-pathological results. In 7 patients with small-bowel diseases and pathological D-Xylose-test, PABA-serum-test was false-pathologically in 6/7 cases. By serum-PABA-time-concentration-curves there was a significant discrimination between patients with chronic pancreatitis and controls at 60, 90, 120 and 150 min (p less than 0.01), but early and late peak concentration of PABA was often found in the two groups. If the PABA-concentration was estimated only 120 min after test meal, diminished test-specificity was found. Peak-PABA-serum-concentration was significantly correlated with lipase output (p less than 0.001) and trypsin output (p = 0.01) at secretin-caerulein test, but PABA was only at low enzyme outputs pathological, showing a moderate sensitivity of test.

[Rationalization of the quantitative determination of fecal fat]. / Untersuchungen zur Rationalisierung der quantitativen Stuhlfettbestimmung.

The stool wet weight/24 h correlated well with chemical fecal fat/24 h (n = 45, p less than 0.0001). The best and simpliest methods for stool homogenization were treatment of stool with starmix or stool dilution with water and shaking for 5 min. The coefficient of variance of one of this methods was as good as by the combined method. The coefficient of variance of fecal fat was significantly lower in homogenized stool specimens than in unprepared stool samples (p less than 0.01), but fat estimation in samples of not homogenized stool (n = 10) of normal persons also showed a significant difference in comparison with samples of stool (n = 15) from patients with malassimilation (p less than 0.01). The titrimetric method for estimation of fecal fat/24 h (van de Kamer) correlated very well with a simple convenient colorimetric method (Tomaszewski) (n = 52, r = 0.979, p = 0.001). There was no significant difference in fat excretion/24 h in two groups of patients with (n = 26) and without fat balance (n = 42).

[Clinical studies using a photometric method for determining serum lipase activity]. / Klinische Untersuchungen mit einem photometrischen Verfahren zur Bestimmung der Serum-Lipaseaktivität.

Results of measurement of serum lipase activity as determined by a UV-test described by Myrick and a titrimetric assay as described by Rick were compared as far as sensitivity and specificity in diagnosis of pancreatitis is concerned. Sensitivity of the UV assay is low (45% falsely normal values), and specificity as well (falsely pathological values in 55.5% of patients with liver disease and 9% of normal persons). In the UV assay lipoproteinlipases are measured as well as hepatic esterases: in 17 samples from persons having received heparin lipase activity was increased 3-8 fold. In a total of 99 samples no correlation was found between the results of the 2 assays. As a consequence it can be stated that the UV-test as described by Myrick has no relevance in diagnosis of pancreatitis; the commercially available assay kit is withdrawn in the meantime.

[Diagnosis of chronic pancreatitis based on the determination of lactoferrin and calcium in the duodenal juice?]. / Diagnostik der chronischen Pankreatitis durch Bestimmung von Laktoferrin und Kalzium im Duodenalsaft?

The diagnostic relevance of measuring calcium and lactoferrin in duodenal juice collected after stimulation is unclear. Concentration and output of these compounds were therefore analyzed after maximal stimulation of the pancreas according to Ribet, the duodenal juice being collected during an endoscopic procedure as described earlier. Kinetics of secretion showed a maximum within the first 10 minutes. Values of calcium and lactoferrin were not statistically different in normal persons (n = 32) and patients with chronic pancreatitis (n = 11). There was a good correlation to concentration of bilirubin (p less than 0.001), however no correlation to concentrations of immunoreactive trypsin and lipase. It must be assumed, that calcium and lactoferrin in duodenal juice are not only of pancreatic origin. These measurements are therefore useless in the diagnosis of pancreatitis.

[Differential diagnostic and prognostic value of methemalbumin determination in acute pancreatitis]. / Differentialdiagnostischer und prognostischer Wert der Methämalbumin-Bestimmung bei der akuten Pankreatitis.

Methemalbumin (MHA) levels of serum or ascites were measured in a prospective study involving 40 patients with acute abdominal symptomatology suspected to have acute pancreatitis. MHA was demonstrated in 15 out of 18 cases, in whom a diagnosis of acute pancreatitis was established later on firm grounds. MHA was positive in all cases with necrotizing pancreatitis, in all cases with a severe course of the disease involving circulatory insufficiency, and, with values significantly higher, in all cases with renal or pulmonary complications. There was no correlation between pathologically increased serum levels of enzyme activity and MHA. In one patient with chronic pancreatitis MHA could be demonstrated in serum, in another one in ascites. In extrapancreatic abdominal disease MHA was falsely positive in 4 out of 15 cases; in no one of these cases were serum enzyme activities elevated. Measurement of MHA can be used in conjunction with measurement of serum enzyme activity as an additional diagnostic and prognostic parameter in acute pancreatitis.

[A fast endoscopic test of pancreatic secretion (endoscopic secretin-caerulein-test) (author's transl)]. / Endoskopische quantitative Pankreassekretionsanalyse als Kurztest (Sekretin-Caerulein-Kurztest [SCKT]).

Measurement of the pancreatic exocrine secretion was performed for 20 minutes using a gastrofiberscope. The exocrine pancreas was stimulated by 1 clin. U./kg secretin and 40 ng/kg caerulein as a bolus injection. Aspiration of duodenal juice was performed by a polyaethylen-tube through the biopsy-channel of the endoscope while duodenum distal of the papilla was shut by a baloon-tube, fixed on the distal end of the gastrofiberscope. In 84 patients the investigation was done 87 times. In 11 cases of proved chronic pancreatitis the endoscopic secretin-caerulein-test (SCKT) was pathologic in each case. --Normal values obtained by SCKT were in the range of those obtained by standard secretin-pancreozymin-test with correction of the volume of duodenal juice. Maximal enzyme output was always found in the first five-minute fraction of duodenal juice. Maximal bicarbonate output was found later between 15 and 20 minutes after stimulation. There was a good correlation between maximal enzyme output and maximal bicarbonate output in SCKT on one side and the results of a standard secretin-pancreozymin-test later performed in the same 10 patients. The SCKT is an easy and fast practicable method to be done after routine gastroscopy.

[Measurement of fecal chymotrypsin. Clinical and methodological aspects (author's transl)]. / Klinische und methodische Untersuchungen zur Bestimmung des Chymotrypsins im Stuhl.

Fecal chymotrypsin activity was measured in 128 samples from 93 persons; the titrimetric procedure (Haverback) was used. Distribution of values in 67 normal persons was slanted positively and was approximatively logarithmical. The lower limit of normal was 120 microgram/g stool. Falsely normal results were obtained in 23% of 45 stool samples from 26 patients with pancreatic insufficiency. Falsely pathological results were found in 3,6% of cases. When chymotrypsin was measured photometrically (Imondi) and when the normal limit was assumed to be 50 microgram/g stool according to the literature, a diagnosis of pancreatic insufficiency was confirmed only in 30% of all patients, and 44% of the results were falsely pathological. Chymotrypsin was measured with both methods in 66 samples; correlation of results was unsatisfactory and definitely lower results were obtained with the photometrical procedure. No correlation could be found as well when chymotrypsin activities were measured in stool homogenates on the one hand, and in the supernatant of stools after centrifugation on the other hand, by the titrimetrical or by the photometrical method. Results obtained titrimetrically as well as photometrically after activation of chymotrypsin in pancreatic juice correlated well; the same was true for 2 photometric procedures tested (Imondi, Nagel). Stimulation of the exocrine pancreas with one Lundh meal did not result in any significant increase of fecal chymotrypsin activity in 12 persons tested.

[Methodological and first clinical investigations using a new pancreatic function test]. / Methodische und erste klinische Untersuchungsergebnisse mit einem neuen indirekten Pankreasfunktionstest

The synthetic peptide N-benzoyl-L-tyrosyl-p-aminobenzoic acid was tested in vitro and in vivo for its chymotrypsin specificity. Comparative kinetic tests with bovine chymotrypsin and human pancreatic juice, as well as clearance tests with p-aminobenzoic acid (PABA), made this peptide seem suitable for an indirect pancreatic-function test. A testing scheme was set up for clinical use which has yielded promising preliminary results. While in 31 out of 32 healthy subjects there were normal PABA excretion rates in the urine collected over six hours, the test correlated well in 15 out of 16 cases of definite pancreatic disorder. The percentage dose excretion of PABA in the urine collected over six hours gave good correlations with the one-hour amount of chymotrypsin in the pancreozymin-secretin-test and with the concentration of chymotrypsin in the feces. These preliminary results make this test appear an appropriate screening method for pancreatopathy.

[Comparison between a titrimetric and a photometric method for determination of serum lipase activity (author's transl)]. / Vergleich zwischen einer titrimetrischen und einer photometrischen Methode zur Bestimmung der Serumlipase

Comparative studies of two methods for the determination of serum lipase activity (SLA) in human serum show in both methods, the one titrimetric the other photometric, a comparable sensivity and comparable results, especially within the group of subjects suffering from pancreactic diseases. The values of SLA within the group of 45 patients with acute and chronic pancreatic diseases and within a control group of 39 persons without pancreatic affections show a marked correlation for each group. The values of SLA obtained with the titrimetric method of Rick are found to be higher, which would be due to better conditions of the procedure. Also in the study of precision the titrimetric method gave a better result. The determination of SLA with both methods includes post-heparin-lipase-activity (PHLA).