RESUMO
In the present study we evaluated the relation among histology, H. pylori, IgG to H. pylori, gastric emptying, and acid secretion in 43 patients with fundic atrophic gastritis. On the basis of gastric acid secretion, patients were divided into three subgroups: patients with preserved acid secretion (Group 1), patients with hypochlorhydria (Group 2), and patients with achlorhydria (Group 3). Fundic glandular atrophy was more severe in hypoachlorhydric patients than in those with preserved acid secretion (P < 0.05 vs Group 2, P < 0.005 vs Group 3). H. pylori colonization was found in 94% of patients in Group 1, in 61% of patients in Group 2, and in only 8% of patients in Group 3 (P < 0.001 vs Group 1, P < 0.05 vs Group 2). Conversely, serological positivity to H. pylori was high in all three subgroups of patients (100% in Group 1, 77% in Group 2, 92% in Group 3). Gastric emptying was delayed in atrophic patients, particularly in those with hypoachlorhydria. Our data suggest that fundic atrophic gastritis represents a possible end stage of H. pylori infection, characterized by a progressive disappearance of the bacterium and a progressive deterioration of gastric functions.
Assuntos
Ácido Gástrico/metabolismo , Esvaziamento Gástrico , Fundo Gástrico , Gastrite Atrófica/complicações , Gastrite Atrófica/fisiopatologia , Infecções por Helicobacter/complicações , Helicobacter pylori , Acloridria/complicações , Adulto , Idoso , Anticorpos Antibacterianos/sangue , Atrofia , Feminino , Gastrite Atrófica/patologia , Helicobacter pylori/imunologia , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-IdadeRESUMO
Our aim was to evaluate the relationship between gastric emptying and demographic, clinical, histological, and secretory features in patients with nonautoimmune fundic atrophic gastritis. Only 31% of 45 patients with fundic atrophic gastritis presented with achlorhydria. Scintigraphic gastric emptying of solids was delayed compared to healthy controls. Patients with achlorhydria showed gastric emptying rates lower than those with preserved acid secretion. Significant, but weak, correlations were observed between emptying rates and both peak acid output (Rs = 0.33) and serum gastrin levels (Rs = -0.36), but not with grading of mucosal atrophy. No symptom differences were observed between patients with or without achlorhydria, but a weak correlation was detected between peak acid output and the severity of epigastric pain (Rs = 0.40). In conclusion, patients with fundic atrophic gastritis present delayed gastric emptying that is weakly related to the reduction of the acid secretion and the raising of serum gastrin levels rather than to the severity of the atrophy.
Assuntos
Dispepsia/fisiopatologia , Esvaziamento Gástrico , Gastrite Atrófica/fisiopatologia , Acloridria/fisiopatologia , Adulto , Idoso , Feminino , Ácido Gástrico/metabolismo , Gastrinas/sangue , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: We sought to evaluate the effect of Helicobacter pylori eradication in patients with fundic atrophic gastritis. METHODS: Acid secretion, gastric emptying, and histology were evaluated in 20 patients with fundic atrophic gastritis and H. pylori infection. After investigation, 10 patients (Group 1) received an eradicating treatment and 10 (Group 2) did not receive any treatment. One year later, the baseline investigations were repeated. Subsequently, patients in Group 2 received the same treatment given to patients in Group 1 and were reevaluated 12 months later. A further follow-up was performed in both groups 36 months after the treatment. RESULTS: At 1-yr follow-up, all the patients in Group 1 were H. pylori negative whereas all the patients in Group 2 were still infected. In Group 1, there was a significant improvement of both fundic atrophy and acid secretion, compared with baseline (p < 0.01). In Group 2, no substantial modification of either histological or functional parameters was observed at the first follow-up; conversely, a significant (p < 0.01) improvement of fundic atrophy and acid secretion was detected in these patients 12 months after eradication of the bacterium. Histological pattern remained unchanged at 36 months of follow-up in both groups. Gastric emptying remained, on the average, unaffected by the treatment; however, three patients with delayed gastric emptying at entry had normal gastric emptying after eradication of H. pylori. CONCLUSIONS: Our data suggest that mucosal atrophy can be reduced or even reversed by the eradication of H. pylori, and this is associated with a recovery of gastric function.
Assuntos
Gastrite/patologia , Gastrite/fisiopatologia , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Antiulcerosos/uso terapêutico , Atrofia/tratamento farmacológico , Atrofia/patologia , Feminino , Seguimentos , Ácido Gástrico/metabolismo , Esvaziamento Gástrico , Fundo Gástrico/patologia , Gastrite/tratamento farmacológico , Infecções por Helicobacter/patologia , Infecções por Helicobacter/fisiopatologia , Humanos , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Compostos Organometálicos/uso terapêuticoRESUMO
OBJECTIVES: The aim of the present study was to evaluate the efficacy and the safety of a short-term regimen (weekend therapy) in the cure of Helicobacter pylori infection and to analyze the factors that may influence the success of the treatment. METHODS: Seventy-one patients with gastric colonization by a tinidazole sensitive H. pylori strain (34 duodenal ulcer and 37 nonulcer dyspepsia) received omeprazole 40 mg o.m. for 7 days (from Monday to Sunday) and bismuth 240 mg q.i.d. + amoxicillin 1000 mg/q.i.d. + tinidazole 500 mg q.i.d. for only 2 days (Saturday and Sunday). Endoscopy, histology, culture, urease test, and susceptibility studies were done at entry and 30 days after treatment. RESULTS: Successful eradication was obtained in 84% of patients. The percentage of eradication was higher in duodenal ulcer patients (94%) than in those with nonulcer dyspepsia (74%; p < 0.05), and in patients who received the treatment during hot weather (94%) than in those who received the treatment during cold weather (74%; p < 0.05). Side-effects were induced by the treatment in 17% of patients, and these were all not severe, self-limiting, short-lasting, and did not require specific treatment. CONCLUSIONS: These data suggested that weekend therapy with high doses of drugs represents an effective, safe, and inexpensive therapeutic approach for the treatment of H. pylori infection, particularly in patients with duodenal ulcer. Furthermore, they also confirm the relevant role that short-term treatments may play in the therapeutic approach to H. pylori infection, and highlight some important aspects influencing short-term schedules.
Assuntos
Gastrite/tratamento farmacológico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Adulto , Idoso , Amoxicilina/administração & dosagem , Antiácidos/administração & dosagem , Antibacterianos/administração & dosagem , Antiulcerosos/administração & dosagem , Esquema de Medicação , Quimioterapia Combinada , Úlcera Duodenal/tratamento farmacológico , Úlcera Duodenal/microbiologia , Dispepsia/tratamento farmacológico , Dispepsia/microbiologia , Feminino , Gastrite/microbiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Omeprazol/administração & dosagem , Compostos Organometálicos/administração & dosagem , Penicilinas/administração & dosagem , Tinidazol/administração & dosagemAssuntos
Amoxicilina/uso terapêutico , Gastrite Atrófica/microbiologia , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Bismuto/uso terapêutico , Feminino , Gastrite Atrófica/tratamento farmacológico , Humanos , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-IdadeRESUMO
In the present study we assessed the diagnostic accuracy of four commercial IgG enzyme-linked immunosorbent assay (ELISA) kits (Autoplate, H.pylori-EIA-Well, Enzygnost, Helori-test) and evaluated the performance of these tests in patients with fundic atrophic gastritis. Serum antibodies to Helicobacter pylori were measured in 70 out-patients attending endoscopy for dyspepsia and 43 patients with non-autoimmune fundic atrophic gastritis. Using the cut-off values recommended by the manufacturers, and comparing serological findings with gastric biopsy results of dyspeptic out-patients attending endoscopy, the four kits showed a sensitivity and specificity, respectively, of 91% and 96%, for Autoplate, 67% and 100% for H.pylori-EIA-Well, 79% and 100% for Enzygnost, and 81% and 96% for Helori-test. Evaluation in patients with atrophic gastritis revealed a high prevalence of antibodies to Helicobacter pylori (84%) and it demonstrated that patients with and those without gastric colonization by this microorganism had a similar rate of seropositivity (76-84% vs 50-78%). In conclusion, our data demonstrate that: a) this assay is a reliable and valid method to detect gastric colonization by Helicobacter pylori; b) positive serum antibody associated with a negative detection of Helicobacter pylori in the gastric mucosa suggests mucosal atrophy; c) patients with fundic atrophic gastritis should be excluded from studies investigating the value of serology in diagnosing Helicobacter pylori infection.
Assuntos
Ensaio de Imunoadsorção Enzimática/normas , Gastrite Atrófica/diagnóstico , Infecções por Helicobacter/diagnóstico , Helicobacter pylori , Estômago/patologia , Adulto , Idoso , Anticorpos Antibacterianos/sangue , Biópsia , Dispepsia/diagnóstico , Estudos de Avaliação como Assunto , Feminino , Gastrite Atrófica/microbiologia , Gastroscopia , Helicobacter pylori/imunologia , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Kit de Reagentes para Diagnóstico/normas , Sensibilidade e EspecificidadeRESUMO
In the present study we evaluated the efficacy and tolerability of two different therapeutic schedules in eradicating Helicobacter pylori. Forty-six consecutive patients (suffering from either peptic ulcer or non-ulcer dyspepsia) with helicobacter pylori infection were randomly allocated to one of the following two groups: group 1 (n = 23) 2 weeks of treatment with bismuth subcitrate tablets (120 mgx4) + amoxycillin capsules (500 mgx4) + metronidazole tablets (250 mgx4); group 2 (n = 23) 2 weeks of treatment with amoxycillin capsules (500 mgx4) + metronidazole tablets (250 mgx4). Endoscopy, histology and bacterial culture were performed at entry, and 30 and 90 days after treatment. Two group 1 patients and one group 2 patient did not complete the treatment. Successful eradication was obtained in 20/21 (95%) patients treated with triple therapy (group 1) and in 17/22 (77%) patients treated with double therapy (group 2) (p = 0.2). Side-effects occurred in 9/21 (43%) patients of group 1 and in 9/22 (41%) patients of group 2 (p = 0.9). These were all self-limiting and required no specific treatment. These data suggest that combined therapy with amoxycillin and metronidazole, with or without bismuth subcitrate, represents a safe and effective therapeutic approach for the treatment of Helicobacter pylori infection. In our series, triple therapy determined a numerically higher eradication rate than double therapy.
Assuntos
Amoxicilina/uso terapêutico , Antiulcerosos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/isolamento & purificação , Metronidazol/uso terapêutico , Compostos Organometálicos/uso terapêutico , Adulto , Bismuto/uso terapêutico , Esquema de Medicação , Quimioterapia Combinada , Úlcera Duodenal/microbiologia , Dispepsia/microbiologia , Feminino , Gastrite/microbiologia , Humanos , Masculino , Fatores de TempoRESUMO
The present study evaluated the effect of a one-day high-dose combined therapy on Helicobacter pylori infection. Thirty-two consecutive patients (suffering from either peptic ulcer or nonulcer dyspepsia) with Helicobacter pylori infection received omeprazole (40 mg) + bismuth subcitrate (240 mg x 4) + amoxicillin suspension (2000 mg x 4) + metronidazole (500 mg x 4), for only one day. Endoscopy, histology, culture, and susceptibility studies were done at entry and 30 and 90 days after the treatment day. Successful eradication was obtained in 23/32 (72%) patients and gastritis had resolved in 95% of these. Side effects were induced by the treatment in 6/32 (19%) patients, but these were all self-limiting, short-lasting, and did not require any specific treatment. Development of bacterial resistance to metronidazole occurred in 6/9 (67%) non-eradicated patients. These data suggest that one-day treatment with high doses of amoxicillin, metronidazole, bismuth, and omeprazole represents an effective, safe, and inexpensive therapeutic approach for the treatment of H. pylori infection.
Assuntos
Gastrite/tratamento farmacológico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Adulto , Amoxicilina/administração & dosagem , Antiulcerosos/administração & dosagem , Doença Crônica , Esquema de Medicação , Quimioterapia Combinada , Feminino , Gastrite/microbiologia , Humanos , Masculino , Metronidazol/administração & dosagem , Pessoa de Meia-Idade , Omeprazol/administração & dosagem , Compostos Organometálicos/administração & dosagem , Úlcera Péptica/tratamento farmacológico , Úlcera Péptica/microbiologia , Resultado do TratamentoRESUMO
We evaluated the "in vitro" sensitivity to amoxycillin and metronidazole of 193 Helicobacter pylori strains isolated from the gastric mucosa of dyspeptic patients. Susceptibility was determined by disc diffusion on agar plates. All the isolates were found to be sensitive to amoxycillin. On the contrary, 12% of the strains isolated from patients never treated for Helicobacter pylori infection and 73% of those isolated from patients who had previously received unsuccessful treatment for Helicobacter pylori infection were found to be resistant to metronidazole. Resistance was more common in women (17%) than in men (4%: p < 0.01) and was not correlated with age. The occurrence of Helicobacter pylori resistance to metronidazole is relatively common in Italy. In vitro testing of Helicobacter pylori sensitivity seems to be important before embarking on treatments aimed at eradicating the bacterium.
Assuntos
Amoxicilina/uso terapêutico , Dispepsia/tratamento farmacológico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Metronidazol/uso terapêutico , Adulto , Idoso , Amoxicilina/farmacologia , Resistência Microbiana a Medicamentos , Dispepsia/microbiologia , Feminino , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Metronidazol/farmacologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fatores SexuaisRESUMO
Helicobacter pylori infection, histological features of the gastric mucosa, and gastric motor and secretory functions were evaluated in 45 consecutive patients with chronic idiopathic dyspepsia. H. pylori infection was found in 60% of dyspeptic patients, compared with 33% of 15 healthy controls (P = 0.1). No difference was detected in basal or stimulated gastric acid secretion between dyspeptic patients and healthy controls. Gastric emptying was significantly (P less than 0.01) delayed in dyspeptic patients compared with healthy controls when standardized for age and sex. Delayed gastric emptying was associated with a low frequency of H. pylori infection, female gender, and young age. Epigastric pain or burning and postprandial fullness were, respectively, more severe in patients with H. pylori infection (P less than 0.02) and in those with delayed gastric emptying (P less than 0.01). These findings support the existence of separate subsets of patients with chronic idiopathic dyspepsia. Despite the presence of overlaps, there appear to be partially different functional derangements and clinical features in different subgroups of dyspeptic patients.
Assuntos
Dispepsia/etiologia , Infecções por Helicobacter/complicações , Helicobacter pylori/isolamento & purificação , Gastropatias/complicações , Adulto , Doença Crônica , Dispepsia/complicações , Dispepsia/metabolismo , Dispepsia/patologia , Dispepsia/fisiopatologia , Feminino , Ácido Gástrico/metabolismo , Esvaziamento Gástrico , Infecções por Helicobacter/patologia , Infecções por Helicobacter/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Gastropatias/patologia , Gastropatias/fisiopatologia , Fatores de TempoRESUMO
Villus atrophy in celiac sprue determines not only a great reduction of the intestinal absorptive surface, but also destroys the underlying microcirculation which depends on the small artery of the villus and the rich network of capillaries. This may result in a significant shortening of the mesenteric vascular bed. We describe three cases of celiac sprue in which duplex Doppler ultrasound flowmetry revealed a high blood flow velocity in the superior mesenteric vein during the acute stage of the disease. A gluten withdrawal diet produced in all cases a restoration of the normal thickness of the mucosa, together with a significant decrease of blood flow velocity in the superior mesenteric vein.
Assuntos
Doença Celíaca/fisiopatologia , Circulação Esplâncnica/fisiologia , Adulto , Idoso , Velocidade do Fluxo Sanguíneo/fisiologia , Doença Celíaca/diagnóstico por imagem , Feminino , Humanos , Veias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , Ultrassom , UltrassonografiaRESUMO
This study aimed to compare fasting and postprandial gastrointestinal motor patterns in patients with ulcer and non-ulcer dyspepsia. Forty five subjects were studied: 10 with uncomplicated gastric ulcer, eight with uncomplicated duodenal ulcer, 18 with chronic idiopathic dyspepsia, and nine healthy asymptomatic controls. Gastrointestinal fasting and postprandial motor patterns were recorded using a low compliance perfusion technique. The interdigestive antral cumulative motility index, computed for 30 minutes before the appearance of duodenal activity fronts, and the number of activity fronts with an antral component were significantly less in patients with ulcers and those with non-ulcer dyspepsia compared with asymptomatic controls. The patient groups also had a reduced antral motor response to a solid-liquid test meal compared with healthy controls. Intestinal motor abnormalities (bursts of non-propagated phasic pressure activity and discrete clustered contractions) were recorded in a minority of patients, all with associated irritable bowel symptoms. In conclusion, antral hypomotility is a frequent but nonspecific motor abnormality in dyspepsia; abnormal motor patterns of the small bowel are less frequent and seem to be confined to patients with concomitant irritable bowel syndrome.
Assuntos
Dispepsia/fisiopatologia , Ingestão de Alimentos/fisiologia , Jejum/fisiologia , Motilidade Gastrointestinal/fisiologia , Úlcera Péptica/fisiopatologia , Adolescente , Adulto , Doenças Funcionais do Colo/fisiopatologia , Úlcera Duodenal/fisiopatologia , Feminino , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Úlcera Gástrica/fisiopatologiaRESUMO
A 43-year-old man with chronic intestinal pseudo-obstruction is presented. He had undergone two laparotomies in an attempt to eliminate the cause of repeated episodes suggestive of obstruction. Gastrointestinal manometry showed severe abnormalities compatible with the diagnosis of chronic intestinal pseudo-obstruction. Laboratory tests indicated the presence of intestinal malabsorption and villous atrophy. A gluten-free diet accompanied by 10 days of treatment with tetracycline and 2 short periods of treatment with cisapride led to gradual, but apparently complete, resolution of the pseudo-obstructive syndrome. Repeated manometric studies showed progressive normalization of both the fasting and postprandial upper gastrointestinal motor pattern.
Assuntos
Motilidade Gastrointestinal , Pseudo-Obstrução Intestinal/terapia , Adulto , Doença Crônica , Cisaprida , Jejum/fisiologia , Humanos , Pseudo-Obstrução Intestinal/dietoterapia , Pseudo-Obstrução Intestinal/fisiopatologia , Pseudo-Obstrução Intestinal/cirurgia , Masculino , Manometria , Piperidinas/uso terapêutico , Tetraciclina/uso terapêuticoRESUMO
We report a case of primary esophageal non-Hodgkin's T-cell lymphoma in a young white female. At admission, endoscopy revealed large, irregularly shaped, esophageal ulcerations with super imposed candidiasis. Endoscopic ultrasonography to assess submucosal alterations and periesophageal involvement revealed a diffuse hypoechogenic thickening (up to 5 mm) of the esophageal wall, a pattern consistent with lymphomatous infiltration. Definitive diagnosis was made with the aid of histology and immunohistochemistry.
Assuntos
Neoplasias Esofágicas/patologia , Linfoma de Células T/patologia , Adolescente , Neoplasias Esofágicas/diagnóstico por imagem , Esofagoscopia , Feminino , Humanos , Linfoma de Células T/diagnóstico por imagem , UltrassonografiaRESUMO
We used Western Blotting analysis to determine the immune profile to Campylobacter pylori polypeptides in: A) sera from patients with idiopathic dyspepsia and bacteriological evidence of C. pylori gastric colonization, B) sera from patients with the same symptoms but no bacteriological evidence of C. pylori infection and C) healthy subjects. To avoid interference of aspecific reactions due to antigenic cross reactivity with other thermophilic Campylobacter species, antisera were raised in rabbits against C. pylori as well as against C. coli and C. jejuni. Some bands (with an approximate molecular weight of 118, 85, 40, 34, 28, 18 and 12 Kd) which can be considered specific for C. pylori were identified and the IgG reaction to some of them (40, 34, 28 Kd) was shown to be significantly higher in patients with bacteriological evidence of C. pylori infection than in the other two groups. IgM reactivity to two bacterial proteins of molecular weight 118 and 40 Kd was particularly evident in the second group of patients suggesting a possible diagnostic tool to identify C. pylori infection at a very early stage.
Assuntos
Anticorpos Antibacterianos/análise , Infecções por Campylobacter/imunologia , Campylobacter/imunologia , Dispepsia/imunologia , Adulto , Especificidade de Anticorpos , Western Blotting , Reações Cruzadas , Feminino , Humanos , Soros Imunes/imunologia , Imunoglobulina A/análise , Imunoglobulina G/análise , Imunoglobulina M/análise , Masculino , Pessoa de Meia-Idade , Peso MolecularRESUMO
A case of single, polypoid metastatic malignant melanoma of the gallbladder is described. The differential diagnosis with primary malignant melanoma and undifferentiated carcinoma is discussed.
Assuntos
Neoplasias da Vesícula Biliar/secundário , Melanoma/secundário , Neoplasias Cutâneas/patologia , Neoplasias da Vesícula Biliar/patologia , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-IdadeRESUMO
Gastric acid hypersecretion and accelerated gastric emptying are commonly considered as possible determinants of duodenal ulcer, but the relative frequencies of these gastric dysfunctions have never been evaluated in a homogeneous group of patients. We studied basal and pentagastrin-stimulated gastric acid secretion and gastric emptying of a radiolabeled caloric liquid meal in 99 consecutive male patients with endoscopically proven, active, uncomplicated duodenal ulcers. Compared to matched healthy subjects, ulcer patients presented increased basal and stimulated acid secretion (P less than 0.001). Sixty-nine patients had peak acid output values above the 95% confidence limits of the control population (14.2-30.6 meq/hr). Cigarette smoking was correlated with gastric acid hypersecretion. No significant difference was found between duodenal ulcer patients and controls in mean gastric emptying times. Ulcer patients showed a greater variance of gastric acid secretion and emptying values than healthy subjects. This reflects varied gastrointestinal function among ulcer patients. No significant correlation was found between gastric acid output and gastric emptying times. These findings suggest that gastric acid hypersecretion, but not accelerated gastric emptying of liquids, play a relevant role in the pathogenesis of duodenal ulcer.
Assuntos
Úlcera Duodenal/fisiopatologia , Ácido Gástrico/metabolismo , Esvaziamento Gástrico , Adulto , Úlcera Duodenal/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Fumar/efeitos adversosRESUMO
The endocrine effects of short-term (4 weeks) and long-term (6 months) oral administration of famotidine (40 and 20 mg nocte, respectively) and ranitidine (300 and 150 mg nocte, respectively), were investigated in 20 male patients with duodenal ulcers. Basal PRL, LH, FSH and TSH serum levels were evaluated and their response to specific releasing factors, and basal blood levels of some sexual (E2, P, T) and thyroid (T3, T4) hormones. None of the treatments modified basal and RH-stimulated levels of PRL, LH, FSH and TSH, nor basal levels of sexual hormones. Regarding the thyroid hormones, no effect was observed during the administration of famotidine. On the contrary, short-term treatment with ranitidine induced a significant decrease in thyroxine serum levels, while no effect was observed during maintenance treatment.