Comparison of Helicobacter pylori genotypes obtained from the oropharynx and stomach of the same individuals - a pilot study.

Helicobacter pylori has been recently detected in the oral cavity and oropharynx. However, the role it plays in oral and oropharyngeal pathogenesis remains unclear. The virulence of H. pylori strains can be distinguished according to the virulence factors genes carried. Our research has been focused on realtime PCR analysis of cagA and vacA genes of H. pylori strains in tonsils and tonsillar squamous cell cancer and their comparison with H. pylori strains obtained from the gastric mucosa of the same patients. Urea breath test (UBT) test was used to detect a gastric H. pylori infection in 20 patients with previously proven H. pylori in the oropharynx. Genotyping of H. pylori in gastric biopsies was performed in patients with positive gastric infection. Out of 20 patients positive for oropharyngeal H. pylori, 8 were positive for concurrent gastric H. pylori infection. In 6 of them gastric biopsies were obtained. Comparison of oropharyngeal and stomach H. pylori genotypes showed important differences. Four of 6 patients had different H. pylori strains in the oropharynx and stomach. The differences were found in cagA gene as well as in vacA gene. The finding of oral presence of H. pylori without concurrent stomach infection was confirmed using UBT. The results show that more than one H. pylori strain can be present in oropharynx and stomach in the same patient. The oropharyngeal infection seems to be independent to the gastric infection.

Lymphocyte proliferative response to Helicobacter pylori antigens in H. pylori-infected patients.

Helicobacter pylori (Hp) contributes to the development of gastric and extra-gastric diseases such as autoimmune thyroiditis (AT), and causes persistent life-long infection despite local and systemic immune response. We determined the specific cellular immune response to Hp antigens and PWM (control mitogen) in two groups of Hp infected patients--group A (n = 21), involving patients with autoimmune thyroiditis and group B (n = 13) of patients without AT--using modified lymphocyte transformation test before and after eradication therapy in comparison with healthy controls (group C, n = 15). Immune reactivity to the majority of Hp antigens (aHp, hHp, HpAg, CagA) was significantly lower in group B before eradication therapy in comparison with healthy Hp negative controls. A significant increase in immune reactivity was observed in group B to certain Hp antigens after successful eradication. The same levels (but insignificant) of immune reactivity were shown in group A. Our results indicate that Hp can cause the inhibition of the specific cellular immune response in Hp infected patients with or without autoimmune diseases such as AT, which can be abrogated by successful eradication of Hp. Lymphocyte transformation test appears to be a good tool for detection of immune memory cellular response in patients with Hp infection.

Helicobacter pylori isolated from patients with tonsillar cancer or tonsillitis chronica could be of different genotype compared to isolates from gastrointestinal tract.

Helicobacter pylori from patients with different diseases, including so-called autoimmune thyroiditis, chronic tonsillitis and tonsillar cancer, was isolated and cultured. It was identified according to the genotype using labeled hybridization probes complementary to six sequences of cagA and vacA genes. Different types of strains were found in isolates from gastrointestinal tract and patients suffering from thyroiditis. Six out of seven genotyped isolates from patients in our Department of Otorhinolaryngology and Head and Neck Surgery exhibited the same genotype, differing from isolates obtained from other patients; the 7th isolate originated from a patient who had undergone surgery for deviatio septi nasi, at the same time suffering from autoimmune thyroiditis, having confirmed gastric infection by H. pylori from biopsy. This data made it possible to formulate the hypothesis on probable association of specific H. pylori genotype with chronic tonsillitis and tonsillar cancer. We assessed commercial transport media and improved nucleic acid isolation techniques and the RT-PCR-based tests, which allowed us to skip a culture step and to test directly the patients' samples; however, for full confirmation of our hypothesis and explanation of possible mechanisms of the contribution of Helicobacter sp. to the pathogenesis of the disease further data are to be collected and evaluated.

[Faecal elastase I--its use in diagnosis of chronic pancreatitis]. / Stanovení elastázy I ve stolici--vyuzití v diagnostice chronické pankreatitidy.

BACKGROUND: The diagnosis of chronic pancreatitis is based on the imaging methods. These imaging methods show the main morphological changes in the pancreatic ducts and its parenchyma, but they do not define the function of the pancreas. The aim of our study was Faecal Elastase I. determination in patients with chronic pancreatitis. The test is a simple, non-invasive method of the investigation of the pancreatic exocrine insufficiency. The Faecal Elastase I occurring in the stool was correlated with the level of the damage of pancreatic tissue together with the control group of the patients with different diagnoses. METHODS AND RESULTS: Faecal Elastase I (mean values in ug/g of stool) detection is a simple, non-invasive method which correlates well with the damage of pancreatic tissue, stemming from chronic pancreatitis. This test is routinely used especially in the diagnosis of chronic pancreatitis. The classification of chronic pancreatitis currently depends on the morphological changes of the pancreatic duct system (the patho-morphological changes). We are currently missing the classification describing simultaneously the morphological changes of the gland and the function of the pancreas. In our studies we have used a newly proposed classification system, which was put together in Bern, 2000 (1). This new system encompasses morphological and functional changes. Faecal Elastase I was determined by a microplate ELISA method using monoclonal antibody to human pancreatic protein. The Faecal Elastase I. was tested in the stool of the 196 patients with chronic pancreatitis stemming from alcoholism. The occurrence of Faecal Elastase I. was classified according to the levels assigned by the classification system. The control group used in this study included 144 patients with different diagnoses. The results demonstrate a very good correlation of Faecal Elastase I. with the grading of the newly proposed classification system of chronic pancreatitis. Patients with the highest levels of the damage of the pancreas had a significantly lower occurrence of Faecal Elastase I. in comparison with the non-pancreatic control group and in patients with chronic pancreatitis who had no clinical complications or damage of endocrine and exocrine functions of the pancreas. CONCLUSIONS: Feacal Elastase I performance plays an important role in diagnosing of the severe cases of chronic pancreatitis and in the follow-up of the chronic pancreatitis in the patients with the intermediate damage of the pancreas.

[Techniques of endoscopic treatment of malignant colorectal adenomas with respect to the subsequent prognosis of the patients]. / Taktika endoskopického osetrení maligních kolorektálních adenomu s prihlédnutím k dalsímu osudu nemocných.

Since 1981 we detected in 45 patients (28 men, 17 women) 31 adenomas with severe dysplasia (ATD; formerly intramucous carcinoma) and 22 invasive carcinomas in the adenoma (IK penetrating beneath the muscularis mucosae). 95% of all findings were in the left colon before the lienal flexure. Patients with ATD were subjected only to endoscopic operation; of 22 of the subjects with IK 15 were recommended for surgery, and endoscopic treatment alone was provided to seven patients. Forty subjects were followed up on a long-term basis (on average for 34 months). Of 23 patients with ATD one female patient died from ischaemic heart disease, the remainder survive without signs of colorectal carcinoma. Of 17 subjects with IK followed up on a long-term basis five died (all after surgery as a result of generalization of the disease). All 7 patients with IK who had only endoscopic treatment survive without signs of relapse of the disease. In patients with ATD the authors consider EP as the definite therapeutic method, if it is feasible from the technical aspect. Patients with ATD and IK who were subjected to EP are checked after 6 weeks. A total coloscopic check-up is made subsequently in subjects with IK during the first year twice a year and in later years once a year, in subjects with ATD after annual intervals for a period of 5-6 years.

[Ultrasonic findings in pancreas divisum]. / Sonografické nálezy u pancreas divisum.

In 36 subjects with pancreas divisum an ultrasonic examinations of the pancreas were made after filling the stomach with 600 ml of fluid. In 27 subjects (75%) it was possible to evaluate the entire pancreas reliably, incl. the area of the dorsal segment. The gastric filling and positioning of the patients during examination improved in 47% the quality of the visualization, in particular in the left half of the pancreas. In three patients sonography revealed marked inflammatory changes in the entire gland. The applied examination procedure protracted the examination time of the pancreas to 30-40 minutes. Aimed ultrasonic examination with gastric filling is recommended as part of the examination procedure in subjects with pancreas divisum.

[Low opening of the cystic duct and parapapillary diverticula--a new syndrome?]. / Nízké vyústení cystiku a parapapilární divertikl--nový syndrom?

The authors proved in a group of 1574 patients (706 men and 868 women) with adequate filling of the bile ducts on endoscopic retrograde cholangiopancreatography (ERCP) that parapapillary diverticula (PPD) are significantly more frequent (p less than 0.001 for both sexes when there is a low opening of the cystic duct, i.e. less than 5 cm above the papilla on X-ray pictures made during ERCP. In women with PPD and a low opening of the cystic duct concrements in the biliary system are significantly more frequent than in PPD with a normal opening (p less than 0.05). The increased incidence of PPD in cases with a low opening of the cystic duct in the authors' patients cannot be ascribed to their age. The low opening of the cystic duct may act as a factor interfering with evacuation of bile and facilitating the formation of hypersaturated bile. During concomitant PPD the low opening of the cystic duct can facilitate and potentiate the action of lithogenic factors known in PPD.

Therapeutic methods of digestive endoscopy in persons of advanced age.

Towards the end of 1988, 85 out of 170 patients indicated for endoscopic papillotomy (EPT) were over 65 years of age, and, of these, 54% were 75 and more. EPT was successful in 90.6% of those over 65. Total morbidity was 4.7% and mortality 1.2%. Endoscopic colorectal polypectomy (EPE) was performed during the same period in 591 subjects. 143 of them (24.2%) were over 65 and had a total of 284 polyps removed. Almost half those polyps were more than 10 mm in diameter. Adenomas of the right colon were at least 3 times as frequent as in asymptomatic subjects aged 45-60 years revealed by screening for colorectal neoplasms in HaemocultR-positive subjects. Particular attention was devoted to patients with malignant polyps and with very broadly sessile adenomas--both could definitively be treated with the endoscopic method. EPT is often the only possible therapy for elderly and high-risk patients. Every colorectal polyp should be evaluated by endoscopy, and EPE, especially in patients of advanced age, is the method of choice when technically feasible.

[Therapeutic methods of digestive tract endoscopy in older persons]. / Terapeutické metody digestivní endoskopie u osob vyssího veku.

By the end of 1988 of 170 patients indicated for endoscopic papillotomy (EPT) 85 subjects were above 65 years of age and of these 54% were 75 years old or above that age. EPT was successful in 90.6% of subjects above 65 years of age. The total morbidity was 4.7% and the mortality 1.2%. Endoscopic colorectal polypectomy (EPE) was performed during the same period in 591 subjects. Of these 143 (24.2%) were above 65 years and in these subjects 284 polyps were removed. Almost half the polyps in these patients had a diameter of more than 10 mm, and adenomas of the right colon were at least three times more frequent than in asymptomatic subjects aged 45-60 years revealed by screening of colorectal neoplasms in HaemocultR-positive subjects. Special attention was devoted to patients with malignant polyps and with very broadly attached adenomas of the left colon. Almost three quarters of patients with very broadly attached adenomas could be definitely treated by the endoscopic method. EPT is in many instances the only possible therapeutic approach in old and risk patients. Every colorectal polyp should be evaluated by endoscopy and EPE is in particular in subjects of advanced age the method of choice, when technically feasible.