Effect of Helicobacter pylori infection on gastric emptying and gastrointestinal hormones in dyspeptic and healthy subjects.

There is no general agreement as regards the effect of Helicobacter pylori infection on gastric emptying in patients with functional dyspepsia. Food releases several gastrointestinal hormones, and some of these are known to contribute to the regulation of gastric emptying. The aim of this study was to investigate the influence of H. pylori on gastric emptying in dyspeptic and healthy subjects and to verify whether different hormone secretion patterns are affected by the presence of the bacterium. Twenty-seven patients affected by functional dyspepsia and 30 asymptomatic healthy subjects entered the study. H. pylori presence was assessed in controls by IgG antibodies to H. pylori and [13C] urea breath test, and that in patients by Warthin-Starry stain on gastric biopsies. After ingesting a standard solid-liquid meal, an ultrasound examination of gastric emptying was performed. Plasma concentrations of gastrin, cholecystokinin, and pancreatic polypeptide were measured in the fasting and postprandial period for 4 hours. The incidence of H. pylori infection was not higher in functional dyspepsia patients than in controls. As regards gastric emptying, no difference was detected between patients and controls with and without H. pylori infection. On the contrary, the presence of H. pylori infection determined alterations in gastrin levels, which were higher in controls than in patients. Basal CCK levels were higher in the H. pylori-negative patients than H. pylori-positive patients and controls. In conclusion, H. pylori infection seems not to cause alterations in gastric emptying, but rather alterations in gastrin levels. In contrast, the altered levels of CCK account for its involvement in the pathophysiology of H. pylori-negative dyspepsia.

Detection of Helicobacter pylori cagA gene by polymerase chain reaction in faecal samples.

OBJECTIVE: The polymerase chain reaction (PCR) has been extensively and successfully used to detect Helicobacter pylori in gastric juice and gastric biopsies. In contrast, the results obtained using faeces as biological samples for PCR are rather conflicting. This may be due to the presence of faecal inhibitory compounds (polysaccharides) which can inhibit the amplification reaction. The aim of this study was to characterize the H. pylori genotype in faecal samples by using specific primers for the cagA gene. To overcome the problem of contamination by polysaccharides, we used a filter-based extraction technique already applied in a previous study. METHODS: Antral and body biopsies were obtained from 30 symptomatic patients undergoing upper endoscopy. PCR was used to detect the presence of H. pylori organisms in faecal samples by using primers selected for the urease gene A. In addition, H. pylori organisms were characterized both in faecal samples and paraffin-embedded biopsies by PCR with specific primers for the cagA gene. RESULTS: All patients showed a positive CLO test (rapid urease test) and evidence of H. pylori by Warthin-Starry stain. PCR detected the urease A gene in the faecal samples of all patients. The cagA gene was detected in the faecal and biopsy samples of 18 subjects (60%). Duodenal ulcer and/or antral erosions were observed in 15 of the 18 cagA-positive patients (83.3%) and in five of the 12 cagA-negative patients (41.7%). Endoscopic features of normal mucosa or gastritis were observed in three cagA-positive patients (16.7%) and in seven cagA-negative patients (56.3%). cagA-positive status was found to be significantly related to the endoscopic features of duodenal ulceration and/or antral erosions. CONCLUSIONS: Our findings prove that faeces are suitable samples for the detection of cagA status. Moreover, they confirm the existence of a significant relationship between cagA-positive status and duodenal ulcer and/or antral erosions.

Diet, physical activity, and gallstones--a population-based, case-control study in southern Italy.

BACKGROUND: Gallstones are a highly prevalent condition; however, the nutritional and lifestyle risk factors of this disease are not well understood. OBJECTIVE: We evaluated the association between diet, physical activity, and incident cases of gallstones diagnosed by ultrasound in a population-based, case-control study. DESIGN: One hundred patients with newly diagnosed gallstones and 290 randomly selected control subjects without gallstones were enrolled in the study. The presence of gallstones was determined by ultrasonography. Both patients and control subjects completed a questionnaire about their usual diet and physical activity for the 12 mo before the ultrasonography. The association between diet and physical activity and risk of gallstone formation was analyzed by using multiple logistic regression. RESULTS: Body mass index and intake of refined sugars were directly associated with risk of gallstone formation, whereas physical activity, dietary monounsaturated fats, dietary cholesterol, and dietary fibers from cellulose were inversely associated with risk of gallstone formation. Saturated fats were a risk factor for gallstone formation and the association appeared to be stronger for men than for women. CONCLUSION: These findings suggest that a sedentary lifestyle and a diet rich in animal fats and refined sugars and poor in vegetable fats and fibers are significant risk factors for gallstone formation.

The influence of Helicobacter pylori eradication on the gastric mucosal content of epidermal growth factor, transforming growth factor-alpha, and their common receptor.

BACKGROUND: The relationship between the expression of epidermal growth factor (EGF) and transforming growth factor-alpha (TGF-alpha) and that of their receptor (EGF-R) in the Helicobacter pylori-infected gastric mucosa has not been completely elucidated. The aim of this study was to examine the interplay between H. pylori colonization and gastric mucosal growth factor content. METHODS: By means of a solid-phase enzyme-linked immunosorbent assay EGF, TGF-alpha, and EGF-R levels and interleukin-1beta (IL-1beta) content, which is considered a marker of chronic inflammation, were evaluated in the antral mucosa of 24 H. pylori-positive patients before and 8 weeks after eradication therapy. RESULTS: After therapy H. pylori was eradicated in 19 patients. The eradication was accompanied by a significant decrease in IL-1beta content and an increase in EGF and TGF-alpha levels. On the other hand, in the five patients in whom the bacterium was not eradicated EGF, TGF-alpha, and EGF-R levels were quite similar to those assayed before therapy, whereas IL-1beta content was still high. CONCLUSIONS: These results suggest that H. pylori exerts an inhibitory effect on the mucosal expression of EGF and TGF-alpha, which are likely involved in the gastric mucosa repair process.

A longitudinal study of alexithymia and psychological distress in inflammatory bowel disease.

A group of 104 patients with inflammatory bowel disease (IBD) was followed longitudinally for 6 months. While anxiety and depression scores were influenced over time by changes in the level of disease activity, there was no significant change in alexithymia scores. The findings support the contention that alexithymia is a stable personality characteristic in some IBD patients, in contrast to anxiety and depression which are state phenomena influenced by the level of disease activity.

A prospective study of the relationship between disease activity and psychologic distress in patients with inflammatory bowel disease.

BACKGROUND: The evaluation of psychologic states is very useful in the management of inflammatory bowel disease (IBD) patients, particularly when related to disease activity (DA). Our aim was to prospectively evaluate the relationship between psychologic distress and DA. METHODS: DA and psychologic distress were evaluated in 104 IBD outpatients by means of clinical criteria and the Hospital Anxiety and Depression Scale (HADS) at base line and after 6 months. Patients were grouped in unchanged, improved, and worsened DA from base line to follow-up. RESULTS: Repeated-measures ANOVA showed a significant group-by-time interaction for HADS anxiety (F = 89.6, P = 0.0001) and depression (F = 3.67, P = 0.03) subscales. CONCLUSIONS: Over time changes in DA significantly affect psychologic distress and are closely related to corresponding increases and decreases in anxiety and depression in IBD patients. Our findings therefore suggest that the assessment of psychologic distress, particularly anxiety, should be included in the clinical management of IBD patients.

Epidemiology of cholelithiasis in southern Italy. Part II: Risk factors.

OBJECTIVE: To determine behavioural, dietary and other common factors associated with new cases of gallstones, diagnosed by ultrasonography, in a prospective cohort study conducted in southern Italy. SUBJECTS AND METHODS: Between May 1985 and June 1986, systematic sampling from the electoral register of Castellana, a small town in southern Italy, yielded 2472 subjects who had had their gallbladder checked for gallstones by ultrasonography. Between May 1992 and June 1993, 1962 out of the 2235 (87.7%) subjects without gallstones at baseline agreed to a further ultrasound examination. At the first survey a standardized questionnaire was administered, inquiring about medical history, diet, cigarette smoking and other behavioural characteristics. Height and weight were also measured, and blood levels of glucose, cholesterol, HDL-cholesterol and triglycerides were determined by standard methods. The same variables were measured at the second survey. The diagnosis of gallstones was made with the same echograph by echographists working in the same department. Multiple logistic regression was used to determine which factors measured at the first survey were associated with the incident cases of gallstones. RESULTS: One hundred and four subjects had developed gallstones, an incidence of 9.7 per 1000 persons per year. Age, body mass index (BMI), weight change, a history of diabetes, constipation (shown by use of laxatives), cigarette smoking, years of schooling, consumption of fried foods and excessive oil, and pregnancy in females, were positively associated with the incidence of gallstones. Consumption of wine, coffee, fish and wholemeal bread was inversely associated. Sex, family history of cholelithiasis, use of oral contraceptives and serum lipids were not independent risk factors for gallstones. CONCLUSION: The results of this study confirm many gallstone-associated factors reported in previous cross-sectional and case-control studies, as well as in other cohort studies based on the clinical diagnosis of gallstones, such as BMI, ageing and wine consumption. Furthermore, use of laxatives, considered a proxy of constipation, appears to be another important independent risk factor for gallstones.

Incidence and risk factors of duodenal ulcer. A retrospective cohort study.

We evaluated the incidence and risk factors of duodenal ulcer (DU) in a cohort of patients who had undergone esophagogastroduodenoscopy in our institution from 1978 to 1982, without then finding a gastric or duodenal ulcer. Six hundred and twenty-one subjects entered the study, and 526 (84.7%) were traced in 1992. Forty-one cases of DU were found, an incidence rate of 6.7 per 1,000 person-years; the male/female ratio was 2:1. The diagnoses of peptic ulcer (PU) were validated by means of medical documentation. The odds ratio of DU was 2.3 (95% confidence interval 0.8-6.3) and 3.5 (1.4-9.0) in the II and III tertile of basal acid output (BAO) compared with the I tertile, and 2.6 (0.8-8.3) and 7.0 (2.3-20.7) in the II and III tertile of maximal acid output (MAO) compared with the I tertile. Cigarette smoking and the presence of PU among siblings of DU patients were risk factors for DU. Multiple logistic regression confirmed only the association of DU with MAO, cigarette smoking, and family history. By means of a nested case-control study, the risk of developing DU was assessed in subjects with Helicobacter pylori (HP) at the biopsy of gastric mucosa performed before the ulcer diagnosis. The odds ratio of DU in HP-positive subjects was 5.0 (95% confidence interval 0.6-45). The results of this study confirm the influence of gastric acid secretion, cigarette smoking, and family history in the pathogenesis of DU and suggest that HP infection not only favors relapse but could have an important role in the onset of the disease.

Alexithymia in inflammatory bowel disease. A case-control study.

The purported association between alexithymia and inflammatory bowel disease (IBD) was investigated in a group of 112 IBD patients (89 with ulcerative colitis and 23 with Crohn's disease) using the well-validated 20-Item Toronto Alexithymia Scale. Alexithymia was assessed also in a group of 112 normal subjects matched for gender, age, and education. The IBD group was significantly more alexithymic than the control group, and no significant difference was found between the ulcerative colitis and Crohn's disease patients. Alexithymia was unrelated to the duration of illness and the level of disease activity. Although the rate of alexithymia in the IBD group (35.7%) was significantly higher than the rate in the control group (4.5%), it is lower than rates of alexithymia that have been found among psychiatric patients with disorders that also have been linked theoretically and clinically with alexithymia.

Dietary habits and colorectal cancer in a low-risk area. Results from a population-based case-control study in southern Italy.

Many epidemiological studies have focused on the relationships between diet and colorectal cancer, but only a few have been conducted in the Mediterranean area. A population-based case-control study was carried out from July 1987 to June 1989 in a low-risk area in Southern Italy. By means of an "ad hoc" tumor registry, 132 diagnosed colorectal cancers were detected during the two years of study. One hundred nineteen of these 132 colorectal cancer cases were interviewed about their personal dietary habits with use of a questionnaire concerning the frequency of consumption of 70 foods or beverages. An equal number of controls was randomly selected from the lists of general practitioners of the area during the same period and interviewed with the same food frequency questionnaire. In a multivariate analysis, the relative risks (RRs) of developing colorectal cancer were estimated according to the different levels of consumption of food groups and selected food items. All RRs were adjusted for age, sex, education, smoking status, and modifications in diet in the previous 10 years. The risk of colorectal cancer increased nearly threefold for the highest level of consumption of foods with a high content of refined sugar [RR = 2.75, 95% confidence interval (CI) 1.26-5.97] and for the consumption of wine (> 1 l/day) (RR = 3.22, 95% CI 1.05-9.88). An inverse relationship was revealed for the highest consumption of raw and cooked vegetables (RR = 0.51, 95% CI 0.25-1.04) and diary products (RR = 0.46, 95% CI 0.22-0.98) and for the consumption of more than two cups of coffee per day (RR = 0.38, 95% CI 0.16-0.89). In this Mediterranean area, the main source of calories, cereals, did not show a significant relationship with colorectal cancer. These findings support the hypothesis that the local Mediterranean dietary pattern could explain the low risk of colorectal cancer.

Familial risk of colo-rectal cancer in a low incidence area in southern Italy.

The risk of colo-rectal cancer (CRC) in subjects with a positive family history (FH+) for malignancy has been assessed by means of a case-control study carried out between 1987-89 in an area of about 215,000 inhabitants in Southern Italy. One hundred and nineteen CRC cases were compared with 119 sex- and age-frequency matched population controls. Detailed pedigrees were collected at the family homes of both cases and controls. The odds ratio (OR) of CRC, adjusted by means of logistic regression for age, sex and number of first-degree relatives, increased with the number of any kinds of cancers in first-degree relatives with a significant linear trend (p = 0.042), while there was no risk with a FH+ for digestive cancer excluding CRC or for other cancers excluding large bowel and digestive organs. The OR (and 95% confidence interval) for CRC was 5.9 (1.64-21.23) for at least one first-degree relative with CRC. After a mutual adjustment between CRC and the other cancers in the families of cases and controls, the risk of CRC with a FH+ for other cancers did not change, revealing a strong association (p = 0.002) for CRC alone. From the analysis of the family history of cancer in the case group, the relative frequency of families that satisfied the criteria for so-called hereditary non-polyposic colo-rectal cancer (HNPCC) was 2.6%. The increased relative risk of CRC observed only in families with FH+ for CRC is a supportive finding for organizing and planning prevention and genetic counselling for these families, whose members should be referred for further assessment.

[Development of an integrated system of family medicine--pathologic anatomy service to start epidemiologic studies on tumors occurring in an area of southern Italy. First results]. / Costruzione di un sistema integrato medici di famiglia--servizi di anatomia patologica per l'avvio di studi epidemiologici sui tumori incidenti in un'area dell'Italia meridionale. Primi risultati.

In Italy there are eight tumor Population-Based Registries (PBRs) that publish incidence data, and only one of them (Ragusa) provides data for Southern Italy. Usually, PBRs are based on data collection from Pathologists and medical records. Our integrated system differentiates from traditional PBRs because the information comes from the General Practitioners (GPs) and is completed with the diagnosis provided by the Pathologists (Ps). During two years we have registered 1,057 new cancers on a middle period population of 212,644. GPs and Ps signed 395 and 879 incident cases, respectively. GPs alone provided 16.8%, Ps alone 62.6%, and either source 20.6% of total cases. After excluding non melanotic skin cancers and bladder carcinoma, the GPs-Ps integrated system counted 828 new cases in two years. These incidence data are the first in our region (Puglia). The 178 cases signed by GPs alone should have been lost if the informations of our PBR had been based only on local Ps' records. Moreover, 94 of GPs cases (11% of total cancers registered) were subjects who moved outside the area for diagnosis and treatment. Even if this article evaluates the effect of under-registration attributable to Ps or GPs, the cancer incidence data and the active involvement of GPs indicate that they could be usefully involved in the registration of cancer data.

[Genetic epidemiology of cholelithiasis. A case-control study of a population]. / Epidemiologia genetica della colelitiasi. Uno studio caso-controllo di popolazione.

Aim of this study is to evaluate the familial risk of cholelithiasis in non hospitalized subjects with and without gallstones. A population sample of 2.472 subjects was examined by echography for gallstones; 220 subjects (92 males and 128 females) had gallstones or had already been cholecystectomized for gallstones. These cases and an equal number of controls were interrogated about the diagnosis of gallstones in their family using a standardized questionnaire. The comparison of the frequency of symptomatic gallstones and cholecystectomies for gallstones in the relatives of cases and controls showed an increase of the relative risk of gallstones in sons of parents with cholelithiasis (OR 2.9, CI 95% 1.2-8.0) and in siblings of subjects with cholelithiasis (if sister with gallstones: OR 2.4, CI 95% 1.05-5.6; if brother with gallstones: OR 2.9, CI 95% 0.6-14.6). The stratification for sex of cases and controls, however, pointed out that the risk increased only in daughters and sisters of subjects with gallstones. There was no statistically significant difference of frequency of gallstones between spouses of cases and controls (chi square, p greater than 0.05). The results of this study confirm that there is a familial risk of gallstones, even if it is evident only in the female relatives of subjects with gallstones, and suggest that probably the main cause of this risk is genetic and not environmental.