Clinical usefulness of serum pepsinogens I and II, gastrin-17 and anti-Helicobacterpylori antibodies in the management of dyspeptic patients in primary care.

BACKGROUND: Several tests have been proposed for evaluating dyspeptic symptoms and their relationship to the underlying gastric disease. Serum pepsinogens and gastrin-17 are known to be useful biomarkers for the detection of gastric pathologies. AIM: To evaluate the capability of screening dyspeptic patients in the primary care by analyses of serum pepsinogens I (sPGI) and II (sPGII), gastrin-17 (sG-17) and the IgG anti-Helicobacter pylori antibodies (IgG-Hp). PATIENTS AND METHODS: Three hundred and sixty-two consecutive patients with dyspeptic symptoms (208 females, mean age 50.6 +/- 16 years, range 18-88 years) referred by general practitioners for upper gastrointestinal endoscopy were enrolled. A blood sample was taken from each subject for IgG-Hp, sPGI, sPGII and sG-17 analyses. RESULTS: Two hundred and eighty-seven patients had a complete screening; of these, 132 resulted positive for Hp infection. Patients with atrophic chronic gastritis showed significantly lower serum pepsinogen I levels and sPGI/sPGII ratio than patients with non-atrophic chronic gastritis. Moreover, by calculating the values of sPGI by sG-17 and sG-17 by sPGII/sPGI, subjects with atrophic chronic gastritis could be distinguished from those with non-atrophic chronic gastritis and from those with normal mucosa, respectively. sG-17 levels were found to be a useful biomarker for the detection of antral atrophic gastritis, while the combination of sPGI, the sPGI/sPGII ratio and sG-17 was found effective in identifying corpus atrophy. CONCLUSION: A panel composed of PGI, PGII, G-17 and IgG-Hp could be used as a first approach in the 'test and scope' and/or 'test and treat' strategy in the primary care management of dyspeptic patients.

Conscious sedation during endoscopic retrograde colangiopancreatography: implementation of SIED-SIAARTI-ANOTE guidelines in Belluno Hospital.

AIM: In this study we describe the results of adoption of local guidelines for conscious sedation (CS) during endoscopic-retrograde-cholangiopancreatography (ERCP) in Belluno Hospital. Local guidelines were created referring to SIED-SIAARTI-ANOTE guidelines for CS in gastrointestinal endoscopy. METHODS: Between January 2002 and February 2004, 300 ERCPs to be performed under CS have been scheduled. According to local guidelines CS was performed by the gastroenterologist assisted by an anesthesia nurse. An anesthesiologist was always on call in the intensive care unit (ICU) for emergencies and could be on the site in less than 5 min. RESULTS: In 278 patients the procedure was performed safely and effectively by the gastroenterologist without any anesthesiological assistance. At follow-up controls patients had either positive or no recollection of the procedure. An anesthesiologist was called in 13 cases to perform deep sedation and in 9 cases to deal with undesired effects (arterial hypertension in 5 patients, 1 episode of bradycardia, 1 of ventricular tachycardia, 1 of atrial fibrillation and 1 of hypoxia). CONCLUSION: In our experience, CS during ERCP can be safely performed autonomously by a gastroenterologist in the majority of cases. Drug prescription protocol and the presence of an anesthesia nurse create ideal conditions for the operator, patient comfort and good results with a low incidence of undesired events and few calls for the anesthesiologist. To allow safe and effective performance of CS, the Department of Anesthesia should promote the in-service training and up dating of gastroenterologists and anesthesia nurses.

[Diagnosis of Helicobacter pylori infections using isotope-selective non dispersive infrared spectrometry with 13C-urea breath test]. / Diagnosi di infezione da Helicobacter pylori mediante spettrometria a raggi infrarossi isotopo-selettiva non dispersiva con 13C-Urea Breath Test.

OBJECTIVE: The 13C-Urea Breath Test (13C-UBT) is a non-invasive simple and reliable test for the diagnosis of Helicobacter pylori infection. Widespread use of the test is limited by the high cost of isotope-ratio mass-spectrometry that is required for analysis of the breath samples. The aim of our study was: 1) evaluate the accuracy of a simple optical method called isotope-selective non-dispersive infrared spectrometry (NDIRS), which is designed to measure 13CO2/12CO2 ratio; 2) evaluate the possibility to reduce timing of breath samples collection after 13C-urea ingestion. METHODS: 13C-UBT and gastroscopy were performed in one hundred patients (mean age: 51 years; range: 18-81 years; M/F: 48/52) after overnight fasting. None had taken antibiotics, proton pump inhibitor or bismuth-containing preparations for at least four weeks. Two biopsies from the antrum and two from the body of the stomach were obtained from each patient to investigate the Helicobacter pylori status. Breath samples were collected from each patient in aluminised plastic bags with a volume of 1200 ml, before and 10, 20 and 30 minutes after ingestion of 75 mg 13C-urea dissolved in 200 ml of orange juice. A value of "Delta-Over-Baseline" higher than 4@1000 was considered positive. The operators of each device were unaware of Helicobacter pylori status. RESULTS: 54/55 patients resulted positive on 13C-UBT in respect of immunohistochemistry. 44/45 patients resulted negative on 13C-UBT in respect of immunohistochemistry. The sensibility resulted 98.1%, specificity 97.7%. No significant difference between sample collection at 10, 20 or 30 minutes after ingestion of 13C-urea was found (Chi square: p: n.s.). DISCUSSION: This study shows that the diagnostic accuracy of infrared spectroscopy is excellent and comparable with data of other authors about conventional isotope-ratio mass spectrometry. No significant difference between sample collection at 10, 20 or 30 minutes after ingestion of 13C-urea was found (Chi square: p: n.s.). Timing of sample collection may be reduced from 30 to 10 minutes with the purpose of cut down more the costs for this test.

Altered plasma and mucosal concentrations of trace elements and antioxidants in active ulcerative colitis.

BACKGROUND: The production of free radicals is increased in inflammatory bowel disease, and trace elements are crucial components of several antioxidants. Trace elements deficiency may therefore compromise the defense against oxidative damage. The aims of this study were to measure plasma and tissue concentration of trace elements and antioxidants and to relate this to disease activity. METHODS: A 10-ml blood sample and six colonic biopsy specimens were obtained from 24 patients with either active ulcerative colitis or in remission and 10 patients with irritable bowel syndrome for measurement of trace elements and trace element-dependent enzymes. RESULTS: Patients with moderately active disease had significantly lower plasma iron, selenium, and glutathione peroxidase levels than patients in remission and controls, whereas no significant differences were found between the zinc and copper values of patients and controls. Mucosal concentrations of zinc and metallothionein were reduced, whereas iron and glutathione peroxidase concentrations were increased in patients with endoscopically active disease as compared with controls and patients in remission. CONCLUSIONS: Patients with ulcerative colitis have altered plasma and tissue levels of trace elements and antioxidant-related enzymes. The resulting reduced protection against free radicals may contribute to the inflammatory process.

Zinc, iron, and peroxidation in liver tissue. Cumulative effects of alcohol consumption and virus-mediated damage--a preliminary report.

In an attempt to elucidate further the mechanisms involved in alcohol-mediated liver damage and the correlation between alcohol and viruses in chronic liver lesions, we determined the levels of liver glutathione (GSH), thiobarbituric acid reactive substances (TBARS), iron (Fe), and zinc (Zn) in 31 patients with chronic viral hepatitis (CAH), 6 with alcohol-related chronic hepatitis (CALD), 6 with alcoholic cirrhosis (AC), 8 with primary biliary cirrhosis (PBC), and 10 healthy controls (C). Liver GSH was significantly lower in CALD and AC patients (p < 0.005). TBARS levels were significantly higher in CAH, CALD, and PBC patients (p < 0.001, < 0.02, and < 0.001, respectively). In CAH patients, alcohol consumption correlated inversely with GSH and directly with TBARS (p < 0.05). Patients with both CAH and alcohol abuse had a further reduction in liver GSH levels (p < 0.005). Tissue levels of Fe were significantly increased in CALD and AC patients with respect to controls and CAH patients, whereas no significant difference was observed in Zn. These data confirm that patients with chronic ethanol exposure reveal a depletion in liver GSH content clearly correlated with an increase in lipid peroxidation and Fe liver storage. On the other hand, these findings appear to suggest no significant change in Zn levels in chronic hepatitis.

Factors influencing the absorption of trace elements in healthy conditions and in gastrointestinal diseases.

Trace element metabolism is regulated by numerous factors among which absorption plays a key role. Nutritional imbalances or diseases affecting the gastrointestinal tract are therefore often implicated in the development of deficiency states. An overview of dietary factors linked to trace element metabolism and intestinal factors influencing absorption is given with special reference to zinc, copper and selenium.

Zinc therapy in Wilson's disease: observations in five patients.

We report our experience with zinc (Zn) therapy in five patients with Wilson's disease (WD). In addition to neurologic examination, evaluation of Kayser-Fleischer rings and liver function tests, copper (Cu) and Zn concentrations in liver tissue, plasma, and urine were periodically evaluated by spectrophotometry. Many of the patients had had side effects due to penicillamine (PCA). Oral Zn sulphate (220 mg tid) reduced the WD symptoms and resulted in normal urinary Cu excretion in all five patients. One patient who had a transient gastric complaint during Zn administration, and in whom a decrease in liver Cu content was not observed, did not show any improvement in liver histology. He resumed PCA therapy after 29 months of Zn therapy. We conclude that long-term Zn treatment in Wilson's disease can be a safe and effective alternative to Cu chelating agents. However, patients should be periodically monitored for their Cu/Zn status to assess patient compliance with therapy.