Helicobacter pylori status, endoscopic findings, and serology in HIV-1-positive patients.

We have carried out a large prospective study of the frequency of H. pylori infection and HIV-1 status in a community of ex-drug abusers including subjects with (N = 210) and without (N = 259) upper gastrointestinal symptoms, endoscopy and serology. Control groups were patients with upper gastrointestinal symptoms not at high risk of HIV-1 infection (N = 219) and asymptomatic blood donors (n = 322). H. pylori was present in 52% of symptomatic community residents having endoscopy and 55% of the control patients with symptoms but not at high risk of HIV-1 infection. H. pylori was less common in HIV-1-positive patients (40%) than those who were negative (66%; P < 0.001). In patients with AIDS (33%), the frequency of H. pylori infection was reduced compared to HIV-1-positive patients without AIDS (53%; P = 0.05). All the residents with AIDS had upper gastrointestinal symptoms. In community residents, peptic ulcer was always associated with H. pylori infection. By H. pylori serology, there was no difference in the frequency of infection in asymptomatic residents (56%) whether HIV-1 positive (55%) or HIV-1 negative (58%) compared with those residents with symptoms. Overall, H. pylori was less common in HIV-1-positive residents (49%) than those who were HIV-1 negative (61%; p < 0.05). This difference was due mainly to the low frequency of infection in residents with AIDS (33%). H. pylori infection is common in HIV-1 positive patients, and only slightly reduced when compared with at-risk HIV-1-negative subjects. Peptic ulcer is associated with H. pylori in HIV-1 infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of peptic ulcer in Helicobacter pylori positive blood donors.

This study aimed to determine the importance of raised antibodies to Helicobacter pylori in an asymptomatic population. A total of 128 asymptomatic blood donors who were seropositive for H pylori and consented to endoscopy were investigated. These subjects were from a population of 1010 blood donors screened for antibodies to H pylori. A questionnaire was completed to determine if any subjects had complained of symptoms, and they subsequently had endoscopy. Altogether 121 of 128 were positive for H pylori by histology and urease test and/or culture and all 121 had chronic active gastritis on histology. Twenty five of these subjects had peptic ulcer (20 duodenal, five gastric), a further 21 had erosive duodenitis, and two were found to have gastric cancer. H pylori associated peptic ulcer disease and duodenitis occur more frequently than previously recognised and this suggests that H pylori infection, even if asymptomatic, is of far greater clinical relevance than originally thought.

Gastric retention of sucralfate gel and suspension in upper gastrointestinal diseases.

This study was designed to compare by scintigraphy the gastric retention of a new dosage form of sucralfate as gel (Gastrogel) with that of sucralfate suspension in 25 patients with upper gastrointestinal symptoms referred for routine endoscopy. After endoscopy 4 subgroups were defined: macroscopically normal mucosa (n = 7), antral gastritis and/or erosions (n = 6), gastric ulcer (n = 6) and duodenal ulcer (n = 6). Each patient received either sucralfate gel or sucralfate suspension in equivalent doses (5 ml containing 1 g sucralfate). Both formulations were labelled with 111 MBq 99mTc-DTPA before administration. The mean value of t1/2 in the total group was significantly longer when patients were taking sucralfate gel (61.6 min) compared to sucralfate suspension (33.8 min) (P < 0.001). The mean values of t1/2 were significantly longer for sucralfate gel compared to sucralfate suspension also among the subgroups (macroscopically normal P < 0.02, antral gastritis P < 0.05, gastric ulcer P < 0.02 and duodenal ulcer P < 0.05). After 2 and 3 hours, the percentage residual activity in the gastric area was significantly higher following administration of sucralfate gel compared to sucralfate suspension. This study has shown that, compared to sucralfate suspension, sucralfate gel persists longer in the stomach of patients with gastritis and peptic ulcer.

Biliary surgery without the surgeon!

Since the introduction of endoscopic retrograde cholangiopancreatography in the 1970s and of endoscopic sphincterotomy (EST) in 1974, endoscopic techniques for the diagnosis and therapy of biliary and pancreatic disorders have proliferated. Although some procedures have become part of routine practice, for example EST for postcholecystectomy bile duct stones and stent insertion for inoperable biliary strictures, the place of others is unclear at present and should be evaluated by prospective randomized clinical trials. The choice of either an endoscopic or a transhepatic approach for biliary disease is usually dictated by local expertise, but these should be regarded as complementary rather than competing techniques, and complex biliary problems should be managed jointly by the endoscopist, interventional radiologist and hepatobiliary surgeon.

Changes in peripheral blood lymphocytes and immune complexes in splenectomized patients: lack of correlation with residual splenic function.

In 47 patients who had undergone splenectomy (31 post-trauma and 16 elective), the percentage levels of T and B lymphocytes, and the T lymphocyte subsets and circulating immune complexes were studied in peripheral blood and correlated with residual splenic function evaluated by means of the pitted red cell count. The T and B lymphocyte levels in splenectomized patients did not differ significantly from those in controls, while OKT8+ lymphocyte levels were significantly higher both after post-trauma and elective splenectomy; there was no significant difference between the two groups of splenectomized patients. Circulating immune complexes were significantly higher both after post-trauma and elective splenectomy only with the C1qBA and C1qSP methods, while there were no differences between splenectomized patients and controls with the KgBSP method. None of the three methods showed significant differences between post-trauma and electively splenectomized individuals. The pitted red cell levels were significantly lower in post-trauma splenectomized patients with respect to electively splenectomized individuals and 22% of post-trauma splenectomized patients had pitted red cell values within the range compatible with the presence of splenosis. The immunological alterations detected did not correlate with the pitted red cell levels, nor were they less evident after post-trauma splenectomy or in patients with pitted red cells compatible with splenosis: this suggests that the occurrence of splenosis is not sufficient to prevent these alterations. Finally, since in our study the average distance from the operation was 5 yr, it is likely that these alterations can be considered as being stable.

Cytophilic antibodies cause leucocyte migration inhibition in coeliac disease.

Leucocyte migration inhibition in response to challenge with gluten fraction III was prevented by pretreatment of coeliac leucocytes with pronase, an enzyme that removes cytophilic antibodies. Leucocytes from healthy volunteers preincubated with serum from untreated and treated coeliac patients showed marked migration inhibition when incubated with gluten fraction III. No migration inhibition was observed with leucocytes from healthy volunteers preincubated with serum from patients with small bowel diseases other than coeliac disease and from other healthy volunteers. Untreated and treated coeliac patients who were leucocyte migration inhibition negative in the direct assay had migration indices in the sensitized range in the serum induced assay. This work is in keeping with a previous suggestion that in coeliac disease leucocyte migration inhibition induced by gluten fraction III is caused by cytophilic antibodies.