Mannan-binding lectin in children with chronic gastritis.

The involvement of mannan-binding lectin (MBL) insufficiency in the pathogenesis of chronic gastritis (CG) in children was investigated. Blood samples were collected from 78 paediatric patients suffering from CG associated with Helicobacter pylori infection (group Hp(+)) and from 41 with the disease not associated with such an infection (group Hp(-)). Control group consisted of 77 children. The frequency of mbl-2 gene mutations and serum protein concentrations did not differ significantly in both groups as compared with controls. An expression of mbl-2 gene in gastric biopsies of CG patients was demonstrated. It was found to be stronger in H. pylori-infected children. The results presented in this paper suggest that MBL deficit/dysfunction probably does not contribute to an increased risk of CG (both associated and not associated with H. pylori infection) in children. However, MBL opsonic effect and/or the lectin pathway of complement activation may be taken into account as possible host defence mechanisms in gastric patients.

A potential double role of anti-Lewis X antibodies in Helicobacter pylori-associated gastroduodenal diseases.

In this study, we found Lewis X (Le(x)) determinants on 68% of Helicobacter pylori isolates from patients with chronic gastroduodenal diseases. Anti-Le(x) IgG were detected more frequently in the sera from dyspeptic children and adults (45 and 46%), with or without proved (culture) H. pylori infection, than in the sera from healthy individuals (14% and 25%). In contrast, the prevalence of anti-Le(x) IgM was higher in the groups of healthy individuals than in the groups of dyspeptic patients. Moreover, anti-Le(x) monoclonal antibody of IgM class enhanced the uptake of Le(x)(+) but not Le(x)(-) H. pylori isolates by phagocytes. In the sera from some dyspeptic patients, we detected Le(x)-anti-Le(x) IgG immune complexes (Le(x) ICs). There was a great difference between children and adults as regards the presence of Le(x) ICs. The immune complexes were found in the sera from nine out of 29 (27%) H. pylori-infected and three out of eight (37%) uninfected adult dyspeptic patients. In comparison, Le(x)-anti-Le(x) IgG ICs were detected only for two out of 18 (11%) H. pylori-infected children. Le(x) ICs were not found in the sera from healthy individuals. Our results suggest that anti-Le(x) IgM may play a protective role in H. pylori infections. In contrast, anti-Le(x) IgG and particularly Le(x)-anti-Le(x) IgG ICs might contribute to the pathogenesis of chronic H. pylori infections.

Proliferative activity of gastric epithelial cells in Helicobacter pylori infected children.

Helicobacter pylori infection has been associated with gastric carcinogenesis. Gastric epithelial cells proliferative rate is accelerated in H. pylori infected adult patients. Our study was performed to evaluate proliferative cell activity in gastric epithelium in the course of H. pylori infection in the early stage of its natural history. Gastric antral biopsy specimens were obtained from thirteen H. pylori positive and seven negative children. To assess replication rates we used nucleolar organiser regions staining with colloidal silver nitrate technique (AgNOR). The number of AgNORs per nucleus, area of single AgNOR, and the quotient of these two parameters (AgNOR content) were analysed. The mean area of AgNOR was lower in H. pylori positive than in negative children. Conversely, both the mean number of AgNOR per nucleus and AgNOR content were higher in infected than non infected subjects. These results show accelerated proliferation of gastric antral epithelial cells in the course of H. pylori infection in children. Such alteration of cell replication occurring in an initial phase of natural history of long lasting infection provides an explanation for the association between acquisition of H. pylori infection in the first years of life and the development of gastric cancer.

Mallory-Weiss syndrome in children.

The aim of the study was to evaluate the incidence and the etiology of Mallory-Weiss syndrome in children. The study population comprised 2720 children aged 5 months to 18 years who had undergone upper gastrointestinal endoscopy. Mallory-Weiss syndrome was diagnosed in eight (0.3%) of the examined children. Endoscopic examination in five of them revealed linear mucosal tears, mostly above and in one case also below the gastroesophageal junction. In three children a linear scar in the lower portion of the esophagus was seen. No signs of active bleeding were revealed in any of the cases. In four children, Mallory-Weiss syndrome was accompanied by gastritis and duodenitis; two of these children had Helicobacter pylori infection. The concomitant diseases were H. pylori-positive duodenal ulcer (1), bronchial asthma and gastroesophageal reflux disease (1), carbon monoxide poisoning (1). In one case Mallory-Weiss syndrome was diagnosed in early pregnancy. Mallory-Weiss syndrome should be considered, along with others, as a cause of acute upper gastrointestinal bleeding in children. There is a great variety of etiologic factors in Mallory-Weiss syndrome in children.

[IgG and IgA immunoglobulins in helicobacter pylori infections of children with chronic dyspepsia before and after two week triple drug therapy]. / Immunoglobuliny IgG i IgA w zakazeniach Helicobacter pylori dzieci z przewlekla dyspepsja przed i po dwutygodniowej trójlekowej terapii.

The aim of this study was to investigate whether serological techniques, ELISA and Western blot, are useful in monitoring treatment of H. pylori-associated chronic dyspeptic symptoms in children. We observed a correlation between a decrease in the anti-H. pylori IgG titer and an effective treatment. So, our results suggested that the ELISA assay conducted with a glycine H. pylori extract can be a good noninvasive assay for monitoring the effectiveness of the therapy. By using the Western blot method, we showed some variation in the specificity of anti-H. pylori IgG produced before and after treatment. However, this variation was not correlated with the effectiveness of the therapy.

Anti-Lewis X IgM and IgG in H. pylori infections in children and adults.

A role of autoimmune processes in the pathology of Helicobacter pylori infections has been suggested. The Lewis determinants present in LPS molecule of H. pylori bacteria have been indicated as the cause of antigenic mimicry. In this study, the prevalence of IgM and IgG antibodies to Lewis X antigen in the sera from children and adults, with or without dyspepsia, infected or not infected with H. pylori, seropositive and seronegative for anti-H. pylori IgG were determined immuno-enzymatically (ELISA). Our results revealed that humans may produce anti-Lewis X antibodies, particularly of IgM class, in the absence of H. pylori infection or H. pylori independent dyspepsia. The production of such antibodies, by healthy children who had never been infected with H. pylori suggested that anti-Lewis X antibodies may occur naturally.

Systemic humoral response to Helicobacter pylori in children and adults.

In this study we compared the development of anti-H. pylori humoral response in adults and children. Two antigens: H. pylori acid glycine extract (GE) and recombinant cagA were used for ELISA and Western blot. Anti-GE IgG were detected in all and anti-cagA IgG in about 50% of H. pylori infected adults and children. The prevalence of anti-GE and anti-cagA IgG in the sera from H. pylori-uninfected children with gastritis/gastroduodenitis was lower than in the sera from healthy adult blood donors. Serum IgA were demonstrated for 71% of H. pylori-infected adults and for a smaller proportion (about 30%) of uninfected adult patients or normal subjects. Such antibodies were detected neither for infected nor for uninfected children. There was an evident difference between the proteins of H. pylori glycine extract recognized by antibodies present in the sera from H. pylori-infected children and adults. The antigen of molecular weight over 107 kDa was recognized exclusively by the sera from 30% of H. pylori-infected adults. The 80-107 kDa bands were recognized more frequently by the sera from adults than from children. In contrast, sera from infected children more frequently than sera from infected adults reacted with the bands of 14 kDa, 19 kDa and 26 kDa. The H. pylori antigens recognized by IgG, produced by infected children and adult patients, should be taken into consideration in the developing of tests for serodiagnosis of H. pylori infection.

Anti-Lewis X antibody and Lewis X-anti-Lewis X immune complexes in Helicobacter pylori infection.

A molecular similarity of Lewis antigens expressed by Helicobacter pylori bacteria and those present in human gastric mucosa has been recognised as a cause of autoimmunity involved in the pathogenesis of chronic type B gastritis and gastric and duodenal ulcers. In this study, the expression of Lewis X determinants was found on 56% of H. pylori strains isolated from patients with chronic gastritis/gastroduodenitis. Anti-Lewis X IgG as well as Lewis X-anti-Lewis X IgG complexes were detected in the sera from patients and even more frequently in the sera from healthy blood donors producing antibodies against surface antigens of H. pylori. It suggested that the initial H. pylori-induced lesions were independent of anti-Lewis X antibody production. When H. pylori bacteria expressing Lewis X antigen were treated with anti-Lewis X monoclonal antibody (mAb) of IgM isotype, they were more susceptible to ingestion by polymorphonuclear leukocytes (PMN) than untreated bacteria. This fact may lead us to believe that anti-Lewis X antibody limits the growth of H. pylori on gastric mucosa.

Serum IgG antibodies in children and adults reacting with Helicobacter pylori lipopolysaccharides.

The presence of IgG antibodies reacting with Helicobacter pylori lipopolysaccharides (LPSs) in sera from children and adults diagnosed as H. pylori-infected, as well as healthy persons, was tested. There was no correlation between the production of antibodies reacting with H. pylori surface proteins and LPSs. Also no correlation between reactivity of tested sera with H. pylori antigens and deep rough mutant (Re types) enterobacterial LPSs was revealed. The prevalence of anti-LPS IgG in randomly selected children was relatively high.

Attachment of Helicobacter pylori strains to human epithelial cells.

The aim of the study was to characterize several clinical isolates of H. pylori as regards the activity and specificity of their haemagglutinins and the involvement of surface sialic acid-specific and heparin-binding compounds in the adhesin of the bacteria to human epithelial cell lines. Although H. pylori strains caused haemagglutination (HA) of sheep erythrocytes, they differed markedly by activity and specificity. On the basis of haemagglutination inhibition study three types of H. pylori strains could be distinguished. The HA of Type I strains was inhibited with fetuin/mucin but not asialofetuin/asialomucin. The HA activity of Type II strains was inhibited with fetuin/mucin and asialofetuin/asialomucin. The HA of Type III strains was not influenced by any of these inhibitors. In vitro, H. pylori strains bound to the cells of human epithelial lines: HeLa, Kato-3, Ags. However, various compounds mediated the binding of H. pylori types distinguished by HA, to epithelial cells. The interaction of some of H. pylori strains with epithelial cells was mediated by bacterial sialic acid-binding compounds. The majority of H. pylori strains used heparin-binding surface compounds to attach to epithelial cells. Clinical H. pylori strains differ by the compounds used in adhesin to epithelial cell lines, however, this process also depends on the expression of appropriate receptors on the host cells.

Serological indicators of Helicobacter pylori infection in adult dyspeptic patients and healthy blood donors.

The levels of IgM, IgG and IgA antibodies reacting with two Helicobacter pylori antigens (glycine acid extract (GE) and a recombinant CagA protein) were determined in the sera from adult dyspeptic patients, positive (H.p.(+)) or negative (H.p.(-)) for H. pylori urease/culture, and from healthy blood donors. All sera were also examined against GE by Western blot (Immunoblot) technique. Similar levels of anti-GE IgG were detected in the sera from all H.p.(+) and almost all H.p.(-) patients and from over 40% of the healthy volunteers. In contrast, higher levels of anti-GE IgA were found in the sera from patients than that from healthy subjects, although such antibodies were not detected in the sera from 30% of the H.p.(+) patients. In general, our results suggest that a combination of ELISA and immunoblot may be more sensitive in the detection of H. pylori infection in dyspeptic patients than the examination of biopsy specimens by culturing or histology.

Electron microscopic study of association between coccoid forms of Helicobacter pylori and gastric epithelial cells.

OBJECTIVE: To investigate the relationship between helical and coccoid forms of Helicobacter pylori and gastric epithelial cells. METHODS: Gastric antral and body biopsies were obtained from eight children, aged 10-17 yr, who underwent diagnostic gastroscopy. Specimens were processed for electron microscopy. The location of organisms and ultrastructural features were assessed with a transmission electron microscope. RESULTS: We observed two morphological forms of bacteria in three of eight H. pylori-positive patients. Helical forms were localized only in the proximity to unchanged or variously damaged mucous cells, but coccoid forms were present only above strongly damaged epithelial cells. CONCLUSION: Coccoid forms of H. pylori are closely associated with damaged gastric mucous cells. Possible explanations for this phenomenon are discussed.

Eosinophilic gastroenteritis.

Eosinophilic gastroenteritis is a disease of rare incidence and unknown etiology. The descriptions of these rare cases refer to adults; there are few reports of children stricken with eosinophilic gastroenteritis. Our study presents a case of eosinophilic gastroenteritis in a 9-year-old girl suffering from recurrent abdominal pain, vomiting, diarrhoea, oedema of the lower extremities and ascites. The diagnosis was based on clinical features and confirmed by histopathologic examination of a biopsy specimen obtained from an upper gastroendoscopy. Food and parasitic allergens as aetiopathogenetic agents were taken into consideration.

T lymphocytes and immunoglobulins in small and large intestinal mucosa in children with ulcerative colitis.

In 52 children, aged 4-16 years, with ulcerative colitis, behaviour of A,M,G,E globulins and T lymphocytes in the small and large intestinal mucosa was evaluated. The investigations were performed both in the acute phase and remission of the disease. In the final stage of the disease, numerous plasma cells with intensive reaction to IgA and IgM were found in the stroma, while on the epithelial surface they were less marked. An intensive reaction to IgA was observed in remission. Reaction to T lymphocytes was found in single mononuclear stroma cells both in the acute phase and in remission.

Morphological and immunohistochemical examinations of the dynamic changes of gastric mucosa associated with the treatment of helicobacter pylori infection in children.

The aim of this study was to investigate the consequence of Helicobacter pylori eradication on gastric mucosa and antral G and D-cells. Forty children, aged 5-17 years with Helicobacter pylori infection were assessed. Helicobacter pylori was detected by a urease test and identified by serological and microbiological methods. Twenty children were again assessed after the therapy (the combination of colloid bismuth subcitrate, amoxycillin and metronidazole). Gastroscopic examination was performed and at least six bioptic specimens were taken from the antrum, body and fundus. Tissue samples, processed with the paraffin method and stained with hematoxyllin and eosin, were assessed. Monoclonal antiserum Gastrin PAP kit 516 and somatostatin PAP kit 512 (DAKO) in the peroxidase-antiperoxidase technique (PAP) have been used to detect G and D-cells. Helicobacter pylori in the gastric mucosa was demonstrated with the Giemsa method. The results show the coincidence of Helicobacter pylori infection and the count of antral G and D-cells and active chronic gastritis in children. After the treatment Helicobacter pylori was eradicated in 70% of children. In 34% of these cases the eradication was followed by a diminution of activity of gastric antral mucosa inflammation and in 20% of these children the resolution of the inflammatory infiltration in the gastric mucosa was seen. A decrease of the antral G and D-cells count and also a diminution of G/D index in these cases were observed.