Helicobacter pylori and epidemic Vibrio cholerae O1 infection in Peru.

In a cross-sectional study of the 1991 Peruvian cholera epidemic, Vibrio cholerae O1 infection was associated with Helicobacter pylori infection, particularly in young children. These data support the hypothesis that hypochlorhydria induced by H. pylori is important in the pathogenesis of diarrhoeal disease.

Enfermedad ulcerosa clorhidropéptica no complicada. Perspectivas y praxis terapéuticas / Clorhydropeptic ulcerous disease without complications: Therapeutic perspective and praxis

La mayoría de las úlceras clorhidropéptica cicatriza cuando se reduce adecuadamente la acción agresora ácida durante una fracción de las 24 horas del día: (a) neutralizando en el lumen de la secreción; (b) actuando sobre receptores en las membranas de las células parietales. Los antagonistas del receptor-2 de la histmina en dosis nocturna única reducen el tiempo total de cicatrización de 90 por ciento de las úlceras duodenales y gástricas a 6 y 8 semanas promediales, respectivamente. La vida media de eliminación es corta, no se acumulan y los efectos colaterales, cuya incidencia real con dosis habituales es muy baja, son reversibles. Los antiácidos ( hidróxido de aluminio ) y bloquedores del receptor-1 de la muscarina ( pirenzepina ) son alternativas de segunda línea en la estrategia terapeútica general. Omeprazol, un bloqueador de la bomba de protones, se acumula intracelularmente y alcanza niveles de inhibición casi total; por ello mismo se restrige su uso a determinados problemas clínicos graves y sólo durante lapsos breves. Bismuto coloidal y sucralfato se adhieren a la base de la úlcera y promueven su curación eficazmente. Prostaglandina E2 y sus análogos combinan la acción antisecretora con la " citoprotección " directa: su indicación principal es la prevención de recurrencias de lesiones gástricas en pacientes bajo tratamiento obligado con anti-inflamatorios no esteroideos. Dosis moderadas de bloqueadores del receptor H2 durante periodos hasta de 2 años disminuyen apreciablemente las recurrencias de la enfermedad ulcerosa común. El tratamiento quirúrgico es apreciable a casos precisos

A possible role of iron deficiency in gastric cancer in Colombia.

Through the efforts of Correa, Cuello, Haenszel, Tannenbaum and others it was learned that the incidence of gastric cancer in certain areas of Narino (Colombia) was among the highest in the world. These areas of high risk for gastric cancer were adjacent to an area of substantially lower risk. Gastric biopsies from healthy volunteers residing in the "high risk" area exhibited a greater incidence of superficial gastritis and chronic atrophic gastritis with and without intestinal metaplasia than those from the low risk area. The latter pathological finding is considered to be a precursor lesion to gastric cancer. Volunteers from the "low risk" area as well as individuals from Cali in the coastal region and Cartegena on the coast, also exhibited a similar spectrum of pathology but at a substantially reduced frequency. Natives of both cities were also at lower risk for gastric cancer than inhabitants of Narino. It was found that the water supply of the "high risk" area contained a higher concentration of nitrate than water in the "low risk" area. Correa et al. hypothesized that the high nitrate concentrations of well water contributed to the formation of N-nitroso compounds in the stomachs of these individuals early in life. The occurrence of this putative carcinogen in combination with the abrasive action of dietary grains contributed to a series of mutations in the gastric epithelium progressing through a sequence of pathologic changes, loss of gastric acid and culminating in gastric cancer. In the current report individuals in a Medellin population who were admitted with abdominal complaints and were found to be iron deficient exhibited the same spectrum of gastric pathology described by previous investigators. Superficial gastritis, chronic atrophic gastritis and achlorhydria have also been described in association with chronic iron deficiency (and/or associated nutritional defects) per se. The development of these lesions are likely to occur within the first two decades of life when iron requirements are maximal. It is suggested that these changes preceed the development of gastric cancer. Bacterial colonization of the achlorhydric stomach may facilitate nitrate reduction and the formation of a putative carcinogen N-nitroso compound(s) from nitrate in the water supply. Additionally, the effects of chronic iron deficiency on host immune defense may compromise these mechanisms and permit tumor growth with minimal immune intervention.