Geographic differences and the role of cagA gene in gastroduodenal diseases associated with Helicobacter pylori infection.

Helicobacter pylori (H. pylori) is the major causal agent of gastritis, peptic ulcer and gastric cancer. Several bacterium genes seem to be involved in the pathogenicity mechanism. One of them, the cagA gene, has been extensively studied and characterized. In this article we have carried out a study of characteristics and genetic variability of cagA gene in different geographic areas of the world. At the same time, we have summarized several studies that evaluate possible relation of cagA with gastroduodenal diseases associated by H. pylori infection. In our study we found that the presence of the cagA gene has been confirmed in more than 60% H. pylori strains distributed throughout the world. The prevalence of cagA genotype is of 65.4% in gastritis patients, 84.2% in patients with peptic ulcer and 86.5% in those with gastric cancer. It shows a high genetic variability of cagA associated with gastroduodenal diseases that could serve as a virulence marker in H. pylori infected subjects. However, the high prevalence of H. pylori cagA positive strains in some geographic areas does not confirm the strong association between cagA and virulence of strains as described in other countries. Nowadays, cagA gene is considered as a marker for the presence of cag pathogenicity island (cag-PAI) in H. pylori genoma. This region contains several genes that has been involved with the production of cytokines that results in an increased inflammation of host gastric mucosa, but its function is unknown. Probably, others bacterium factors, such as susceptibility host and environmental cofactors could influence in the risk of developing different gastroduodenal diseases associated with H. pylori infection.

[Mallory-Weiss syndrome. Considerations on 27 cases]. / Síndrome de Mallory-Weiss. Considerações sobre 27 casos.

Twenty seven patients, inspected by endoscope, and diagnosed as having the Mallory-Weiss syndrome, have been studied taking into account their age, sex, background, clinic presentation, manifestations, number of lacerations, associated lesions and evolution. Twenty three of them were males and 4 females. The age average was 46.7 years. Only 8 patients had intra-abdominal increased pressure, suffering retching and vomiting 7 of them, while one had a cough access. Out of the 21 patients that we controlled, 9 were chronic alcoholism while 3 had ethanol intoxication previously. Immediate prior ingestion of salicylates had taken place in 6 patients. The clinical presentation of 22 of them was gastrointestinal bleeding, that is, 4.9% of all the upper endoscopies carried out within the bleeding patients. Single laceration was present in 22 cases, double one in 4, and triple in 1. We have frequently found endoscopy lesions associated, the most common one (37%), was hiatal hernia. They all were medically treated except one, who was operated because of gastric perforation was associated. Just one of the Mallory-Weiss syndrome patient died, due to an associated diffused bleeding gastritis.

Sindrome de Mallory-Weiss. Consideracoes sobre 27 casos. / Mallory-Weiss syndrome.Considerations on 27 cases

Foram estudados 27 pacientes com diagnostico endoscopico de sindrome de Mallory-Weiss, valorizando os seguintes parametros: idade e sexo, antecedentes, forma de apresentacao, manifestacoes clinicas, numero de dilaceracoes, lesoes associadas e evolucao. Vinte e tres pacientes eram do sexo masculino e 4 do feminino. A idade media foi de 46,5% anos.Somente em 8 foram encontrados antecedentes de aumento de pressao intra-abdominal: 7 com nauseas e vomitos e um com acesso de tosse.Dos 21 doentes controlados nesta serie, 9 eram etilistas cronicos e 3 apresentaram uma intoxicacao alcoolica aguda. Seis contavam uma ingestao recente de salicilatos. Em 22 pacientes a forma de apresentacao foi uma hemorragia digestiva, correspondendo a 4,9% do total de sangrantes nos quais foi realizado endoscopia digestiva alta. Em 22 casos a dilaceracao era unica, em 4 haviam duas dilaceracoes e em um, tres lesoes lineais. Com frequencia foram encontradas lesoes endoscopicas associada, sendo mais comum a hernia hiatal (37%). O tratamento foi medico em todos os casos, salvo em um, no qual foi necessario a cirurgia por uma perfuracao gastrica associada. Um paciente com sindrome de Mallory-Weiss e gastrite erosiva faleceu, sendo a gastrite erosiva a causa principal da hemorragia e do obito