[The endoscopic and clinical features of Indigo Naturalis-associated ischemic lesions of colonic mucosa]

OBJECTIVE

By analysing the clinical features of Indigo Naturalis-associated ischemic lesion of colon mucosa to improve the precautionary and therapeutic level of the disease.

METHODS

Thirteen patients diagnosed as Indigo Naturalis-associated ischemic lesion of colon mucosa in Peking University Third Hospital from 2005 to 2010 were reviewed. The endoscopic and clinical features were analysed.

RESULTS

The 13 patients with an average age of (60.6 ± 14.1) years old were prescribed Chinese traditional medicine containing Indigo Naturalis for psoriasis or idiopathic thrombocytopenic purpura (ITP). The ratio of males to females was 1:1.6. The typical manifestations were abdominal pain and bloody stool with watering diarrhea before bloody stool in 61.5% patients. Endoscopic and pathological characteristics were coincident with ischemic lesion and more like a chronic index. Vasodilatic medicine was effective and the average hemostatic time was (1.7 ± 0.8) days. The prognosis was well and no recurrence was found during 3 months follow-up.

CONCLUSIONS

Patients having psoriasis or ITP treated with Chinese traditional medicine containing Indigo Naturalis have an inclination to colon mucosa lesions, even ischemic lesion. Careful assessment and observation before prescribing are necessary in these patients.

Three aromatic amino acids in gastric juice as potential biomarkers for gastric malignancies

For screening early-stage gastric malignancies, the existing serum biomarkers have limited sensitivity and specificity. Gastric juice biomarkers are scarce and require further investigation. We divided this study on searching potential biomarkers into four parts: (1) detection of differential fluorescence spectrum and peaks in the gastric juice from patients using fluorescence spectroscopy and HPLC, (2) identification and validation of differential peaks using LC/MS and NMR, (3) quantification of potential biomarkers, and (4) establishment of diagnostic detection. The fluorescence intensity (FI), tyrosine, phenylalanine, tryptophan and total protein content were significantly higher in the gastric juice of patients with gastric malignancies (all P<0.01). With all P<0.001, the areas under the receiver operating characteristic curves of the biomarkers were tyrosine, 0.838; phenylalanine, 0.856; and tryptophan, 0.816. At a specificity of 79.4%, the sensitivity for gastric malignancy detection with phenylalanine was 87.9% only. Aromatic amino acids in gastric juices could be used as potential diagnostic biomarkers to screen gastric malignancies. It is a less-invasive and economical method compared to gastric biopsy.

Furano-1,2-naphthoquinone inhibits EGFR signaling associated with G2/M cell cycle arrest and apoptosis in A549 cells

Furano-1,2-naphthoquinone (FNQ), prepared from 2-hydroxy-1,4-naphthoquinone and chloroacetaldehyde in an efficient one-pot reaction, exhibits an anti-carcinogenic effect. FNQ exerted anti-proliferative activity with the G(2)/M cell cycle arrest and apoptosis in A549 cells. FNQ-induced G(2)/M arrest was correlated with a marked decrease in the expression levels of cyclin A and cyclin B, and their activating partner cyclin-dependent kinases (Cdk) 1 and 2 with concomitant induction of p53, p21, and p27. FNQ-induced apoptosis was accompanied with Bax up-regulation and the down-regulation of Bcl-2, X-linked inhibitor of apoptosis (XIAP), and survivin, resulting in cytochrome c release and sequential activation of caspase-9 and caspase-3. Western blot analysis revealed that FNQ suppressed EGFR phosphorylation and JAK2, STAT3, and STAT5 activation, but increased in activation of p38 MAPK and c-Jun NH2-terminal kinase (JNK) stress signal. The combined treatment of FNQ with AG1478 (a specific EGFR inhibitor) significantly enhanced the G(2)/M arrest and apoptosis, and also led to up-regulation in Bax, p53, p21, p27, release of mitochondrial cytochrome c, and down-regulation of Bcl-2, XIAP, survivin, cyclin A, cyclin B, Cdk1, and Cdk2 in A549 cells. These findings suggest that FNQ-mediated cytotoxicity of A549 cell related with the G(2)/M cell cycle arrest and apoptosis via inactivation of EGFR-mediated signaling pathway.

[Risk factors associated with failure from endoscopic therapy in acute non-variceal upper gastrointestinal bleeding]

OBJECTIVE

To determine risk factors associated with failure of endoscopic therapy in acute non-variceal upper gastrointestinal bleeding (ANVUGIB ).

METHODS

This was a retrospective cohort study of 223 patients admitted to Peking University Third Hospital between 1 January 2005 and 31 December 2009, with acute non-variceal upper gastrointestinal bleeding. Data on clinical presentation, laboratory test, endoscopic findings, and treatment outcomes were collected. Risk factors for treatment failure were identified using multivariable Logistic regression with backward selection.

RESULTS

Therapeutic failure rate was 19.3%(43/223). In univariate analysis, the two groups had significant difference in age, history of gastrointestinal bleeding, ASA, shock, haemoglobin level, Hct, PLT, time of endoscopic treatment, gastric ulcer, duodenal ulcer, lesion size and active spurting of blood. Multivariate Logistic regression analysis revealed that shock [odds ratio (OR) 3.058, 95% confidence interval (CI) 1.295-7.221], history of gastrointestinal bleeding (OR 2.809, 95% CI 1.207-6.539), PLT>100×10⁹/L (OR 0.067, 95% CI 0.009-0.497), active spurting of blood (OR 10.390, 95% CI 2.835-38.080) and lesion size≥2.0 cm (OR 7.111, 95% CI 1.628-31.069) were risk factors associated with failure of endoscopic therapy. The number of comorbidities>1 (OR 9.580,95%CI 1.383-66.390) and active spurting of blood (OR 9.971, 95% CI 1.820-54.621) were factors related with need for surgical intervention or death.

CONCLUSION

Patients with shock, history of gastrointestinal bleeding, PLT<100×10⁹/L, active spurting of blood and large lesion size, have high risks for continued bleeding or rebleeding after endoscopic treatment. These patients may be more likely to benefit from aggressive post-hemostasis care.

[Evaluation of capsule endoscopy on the diagnosis of gastrointestinal diseases]

OBJECTIVE

To investigate the diagnostic value of capsule endoscopy in patients with gastrointestinal diseases of unknown causes (especially with small intestinal diseases).

METHODS

The clinical data and images from M2A capsule endoscopy of 100 consecutive patients from 2004 to 2009 in Peking University Third Hospital were analyzed. These patients were followed up by telephone.

RESULTS

The patients with metoclopramide (10 mg, intramuscular injection) had a significantly shorter gastric transit time in capsule endoscopy than those without metoclopramide (15.0 min vs 30.5 min, P=0.019). Among the patients with obscure gastrointestinal bleeding (n=40), abdominal pain or discomfort (n=35) and diarrhea (n=18), the rate of definitive diagnosis was 60.0%, 80.0% and 72.2%, respectively. The overall diagnostic yield of capsule endoscopy was 67.6%, 42.9% and 44.4%. The accuracy of capsule endoscopy was 75.0%, 92.9% and 84.6%. The sensitivity of capsule endoscopy for small intestinal diseases was 77.3%, 87.5% and 66.7%. The specificity was 50.0%, 95.0% and 90.0%. The positive predictive value was 94.4%, 87.5% and 66.7%. The negative predictive value was 16.7%, 95.0% and 90.0%, respectively.

CONCLUSION

M2A capsule endoscopy with its high diagnostic value was a good method in the diagnosis of gastrointestinal diseases, especially in the patients with small intestinal diseases. There were differences in aspect of the diagnostic value among patients with different indications. Metoclopramide was helpful to reduce the gastric transit time of patients referred for capsule endoscopy.

[A case report of collagenous gastritis in a young Chinese woman and literatures review]

OBJECTIVE

Collagenous gastritis is a rare entity, characterized by the deposition of a subepithelial collagen band with an inflammatory infiltrate in the mucosa. This report describes the first case of collagenous gastritis occurring in a young Chinese woman and reviews the literatures.

METHODS

The patient underwent the gastroscopy screening, and the biopsy specimens were treated with HE staining, Masson staining, Congo red staining and Warthin-Starry staining.Patients' clinical data was discussed and followed up.

RESULTS

A twenty-year-old girl had intermittent epigastric pain for 4 years, abdominal distention, hiccup and weight loss for two months. The gastric endoscopy revealed diffuse white nodular appearance of the mucosa in angular incisura and antrum. Pathologic examination of the gastric biopsies from the antrum and angular showed a subepithelial collagen deposition with moderate infiltrates of lymph plasma cells and eosinophils of the lamina propria. The collagen band measured up to 120.3 µm (mean 43.8 µm). Prednisone 20 mg/d for 4 weeks led to clinical remission and weight gain.

CONCLUSION

There are about 40 cases in literatures to date, and the cause and pathogenesis of collagenous gastritis remain unknown. According to the clinical and pathological characteristics, the patient in this article is the subtype of collagenous gastritis that occurring in children and young adults. Specific therapy has not been established, the gluten-free diet and glucocorticosteroid may be helpful to relieve symptoms in collagenous gastritis patients.

[Characteristics and risk factors of lymphatic metastasis in early gastric cancer]

OBJECTIVE

To summarize the characteristics of regional lymph node metastasis in patients with early gastric cancer and analyze the risk factors for lymphatic metastasis.

METHODS

103 cases surgically treated for early gastric cancer in the Third Hospital of Peking University between March, 1988 and March, 2009 were analyzed retrospectively. Several clinical pathologic variables including patients' age, gender, size of tumor, tumor location, macroscopic type, histological type, invasion depth were investigated by using chi-square test and logistic regression analysis for the possible relationship to lymphatic metastasis.

RESULTS

The rate of lymph node metastasis in early gastric cancer was 17.5% (18/103), which in mucosal cancer was 4.1% (2/49). Submucosal cancer had a lymph node metastatic rate of 29.6% (16/54). Logistic regression indicated that invasion to submucosa and tumor size > 2 cm were independent risk factors for lymph node metastasis of early gastric cancer. Metastatic cases of mucosal cancer were all signet ring cell cancer with diameters more than 2 cm. Lymph node metastatic rate in submucosal cancers within 2 cm was 16.1%(5/31), that in > 2 cm submucosal cancers was 47.8% (11/23) (P = 0.012). Rate of lymph node metastasis in well-differentiated cancers was 0(0/13), that in moderately-differentiated, poorly differentiated and signet ring cell cancers were 18.2% (4/22), 16.7% (5/30) and 23.7% (9/38) respectively (P = 0.294). Patients' age, gender, tumor location and macroscopic type showed no relationship with lymph node state.

CONCLUSION

The tumor size and invasion depth are related with lymph node metastasis in early gastric cancer, considering these factors and assessing lymph node state is essential to appropriate therapeutic options for early gastric cancer.

[Evaluation of the effect of ilaprazole on intragastric pH in patients with duodenal ulcer]

OBJECTIVE

To evaluate the effect of ilaprazole enteric tablets on intragastric pH in duodenal ulcer patients.

METHODS

A randomized, double blind, positive controlled clinical trial was carried out. A total of forty-two patients with duodenal ulcer were randomized into low dose ilaprazole group (5 mg/d), medium dose ilaprazole group (10 mg/d), high dose ilaprazole group (20 mg/d) and omeprazole group (20 mg/d). An ambulatory 24 hour intragastric pH study was performed at the fifth treatment day. Fraction time pH above 3, 4 or 5, median values of 24 hour diurnal pH and 12 hour nocturnal pH, the percentage of patients with total time pH above 3, 4 or 5 at least for 18 hours were evaluated.

RESULTS

There were no significant differences of fraction time pH above 3 or 4, median values of 24 hour diurnal pH and 12 hour nocturnal pH and the percentage of patients with total time pH above 3, 4 or 5 at least for 18 hours among all the groups with different doses of ilaprazole and the omeprazole group. The fraction time pH above 5 in medium and high dose ilaprazole groups were (87.96 + or - 12.29)% and (89.86 + or - 15.18)% respectively, which was higher than that in low dose ilaprazole group [(67.17 + or - 30.16)%] and omeprazole group [(76.14 + or - 16.75)%], P < 0.05.

CONCLUSION

Ilaprazole has a strong effect on intragastric acid control with a dose dependent trend.

Recent changes in the prevalence of Helicobacter pylori infection among children and adults in high- or low-incidence regions of gastric cancer in China

BACKGROUND

The prevalence of Helicobacter pylori (H. pylori) infection varies by geographic locations. Studies indicate that the infection rate of H. pylori was previously high in China but that rates had been declining worldwide over recent decades.

THE AIMS OF OUR STUDY WERE

(1) to determine the current prevalence of H. pylori infection among children and adults residing in areas with high (Muping County, Shandong) and low (Yanqing County, Beijing) incidences of gastric cancer in China, and (2) to compare the prevalence for 2006 with the prevalence for the early 1990s.

METHODS

Using Warthin-Starry silver staining of gastric mucosal biopsy specimens and H. pylori stool antigen tests (HpSA), we tested a total of 2065 asymptomatic children aged 8 - 15 years and adults aged 40 - 79 years in the above two regions from May to July 2006. We evaluated 520 children and 526 adults from Muping, and 516 children and 503 adults from Yanqing. Subjects were selected randomly and H. pylori status was determined by HpSA in children and either HpSA or histology of gastric biopsies in adults. Data obtained in the early 1990s in the same two areas of China were also collected and studied.

RESULTS

For children, the prevalence of H. pylori infection was significantly higher in Muping (37.69%) than it was in Yanqing (25.58%, P < 0.001). In both regions, the prevalence of H. pylori increased with age but was not related to gender. A significant difference was observed between 8 - 9-years old and 10 - 11-years old (P < 0.05), but not between other adjoining age groups (P > 0.05). From 1991 to 2006 H. pylori prevalence among 8 - 10-year-old children decreased in Muping (60.00% vs 32.07%, P < 0.001), but not Yanqing (24.06% vs 19.10%, P > 0.05). In the adult group, H. pylori prevalence was 50.95% in Muping, which was significantly higher than the 41.35% positive rate in Yanqing (P < 0.01). But there were no statistically significant differences between different age groups of 40 - 49, 50 - 59, and 60 - 79 years, or between males and females. A significant decrease in H. pylori prevalence in both regions was observed when the results of 2006 were compared with the data obtained in 1990 in Muping (50.95% vs 73.78%, P < 0.001) and in 1992 in Yanqing (41.35% vs 55.35%, P < 0.01).

CONCLUSIONS

After fifteen years, the prevalence of H. pylori infection among both children and adults remained significantly higher in areas with a high incidence of gastric cancer in China compared with that in areas with a low incidence of gastric cancer. H. pylori infection rates have decreased in the general Chinese population during recent years.

Rapid diagnosis of tuberculosis directly from clinical specimens using a gene chip

The aim of this study was to explore a gene chip capable of detecting the presence of Mycobacterium tuberculosis isolates directly in clinical sputum specimens and to compare it with current molecular detection techniques. At first, we selected 13 M. tuberculosis-specific target genes to construct a gene chip for rapid diagnosis. Using the membrane array method, we diagnosed M. tuberculosis by gene chip directly from 246 sputum specimens from patients suspected of having tuberculosis. Among 80 M. tuberculosis complex (MTBC) culture-positive sputum specimens, the MTBC detection rate was 62.5% (50/80) by PCR-restriction fragment length polymorphism (RFLP), 70% (56/80) by acid-fast staining, and 85% (68/80) by the membrane array method. Furthermore, subspecies showed different gene expression patterns in the membrane array. In conclusion, MTBC could be detected directly in sputum by the membrane array method. The rapidity of detection and the capability of differentiating subspecies could make this method useful in the control and prevention of tuberculosis.

Dilated intercellular spaces in gastroesophageal reflux disease patients and the changes of intercellular spaces after omeprazole treatment

BACKGROUND

Gastroesophageal reflux disease (GERD) is a common disorder. Dilation of intercellular spaces of esophageal epithelium has been revealed at transmission electron microscopy both in the rabbit acid-perfused esophagus and in esophageal biopsies from GERD patients. This study aimed to observe the changes of the intercellular spaces of squamous epithelium of lower esophagus in patients with GERD and the changes of intercellular spaces of patients with erosive esophagitis (EE) before and after omeprazole treatment.

METHODS

Outpatients having GERD symptoms for more than 3 months and volunteers were collected. All of them underwent gastroendoscopy and 24-hour ambulatory pH monitoring. Biopsies were taken from the lower esophagus (2 cm above Z-line) for electron microscope examination. Five healthy volunteers, six non-erosive reflux disease (NERD) patients, and five EE patients were enrolled. Intercellular spaces of GERD patients and controls were calculated. Then we selected 20 patients with EE diagnosed by gastroendoscopy. All of them were treated with omeprazole (Losec, 20 mg bid) for 4 weeks then underwent gastroendoscopy again. Biopsies were taken from 2 cm above Z-line for electron microscope examination. All the patients completed the questionnaire about reflux symptoms before and after treatment.

RESULTS

Intercellular spaces of esophageal epithelial cell in volunteers, NERD patients and EE patients were (0.37 +/- 0.07) microm, (1.31 +/- 0.08) microm, and (1.33 +/- 0.14) microm, respectively, with significant differences between the control group and the NERD group (P = 0.000). In the 20 EE patients, the mean intercellular space before treatment was (1.14 +/- 0.15) microm. After treatment the intercellular space was (0.51 +/- 0.18) microm, a significant difference compared with pre-treatment measurements (P = 0.000).

CONCLUSIONS

Dilated intercellular spaces (DIS) were seen in both NERD and EE cases. The dilated intercellular spaces of esophageal epithelium in EE patients could be recovered after a short time of treatment with omeprazole.

[The risk factors of reflux esophagitis in Shandong farmers]

OBJECTIVE

To investigate the risk factors of reflux esophagitis (RE) in farmers of Shandong province.

METHODS

Five hundred and fifty six peasants (aged from 34 to 90 years old) were randomly selected from the rural general population in Yantai area, Shandong province. All participants received a face to face interview for relating clinical symptoms. Upper gastrointestinal endoscopic and histopathologic examination were carried out.

RESULTS

101 (18.2%) patients were diagnosed endoscopically as RE. According to Los Angeles Classification system, the distribution of types was as follows: A: 36.6% (37/101), B: 56.4% (57/101), C: 3.0% (3/101), D: 4.0% (4/101). The gender (P < 0.001), age (P = 0.041), time engaged in farming (P = 0.040) of the subjects and the length from Z line to fore-tooth (P = 0.001) were correlated with the occurrence of RE. Smoking (OR 1.894, 95% CI 1.207 - 2.974), drinking strong tea (OR 2.900, 95% CI 1.651 - 5.092), using non-steroidal anti-inflammatory drugs (NSAIDs) (OR 2.159, 95% CI 1.166 - 3.997) and loose cardia (OR 13.630, 95% CI 7.37 - 25.19) were risk factors of RE. But there was no relationship between RE and the height, body weight, abdominal circumference, body mass index (BMI), alcohol drinking, special food habit and the history of diabetes, previous abdominal operation, peptic ulcer and atrophic gastritis of the subjects. H.pylori infection rate in the population was 51.3% (273/532). 37.1% (36/97) of RE patients and 54.5% (237/435) of non-RE patients were H.pylori positive (P = 0.002), OR 0.492 (95% CI 0.313 - 0.776).

CONCLUSIONS

Male gender, aging, shorter length from Z line to fore tooth, loose cardia and absence of H.pylori infection were correlated with RE. Smoking, drinking strong tea, NSAIDs and long time engaged in farming were risk factors of RE.

[The changes of esophageal epithelial intercellular spaces before and after omeprazole treatment in erosive esophagitis]

OBJECTIVE

To observe the changes of ultra-micro structure of esophageal epithelium in patients with erosive esophagitis before and after omeprazole treatment.

METHODS

20 patients with erosive esophagitis diagnosed with gastroscopy were enrolled. All of them were treated with omeprazole (20 mg, 2/d) for 4 weeks, then underwent gastroscopy again. Biopsies were taken from 2 cm above Z-line. All the patients completed the questionnaire about reflux symptoms before and after the treatment.

RESULTS

Before the treatment the mean, maximal and minimal intercellular spaces of esophageal epithelium were (1.14+/-0.15) microm, (1.47+/-0.15) microm and (0.85+/-0.17) microm respectively; after the treatment the mean, maximal and minimal intercellular spaces of esophageal epithelium were (0.51+/-0.18) microm, (0.72+/-0.25) microm, (0.36+/-0.15) microm respectively, with significant differences before and after the treatment (P=0.000).

CONCLUSION

The dilated intercellular spaces of esophageal epithelium in erosive esophagitis patients can be recovered after a short time treatment of proton pump inhibitors.

Distinct roles of VEGF-A and VEGF-C in tumour metastasis of gastric carcinoma

The expression of VEGF-A and -C was investigated immunohistochemically in 51 specimens of gastric carcinoma. The expression intensity was evaluated by means of a semi-quantitative scoring system and a quantitative analysis. The results showed that VEGF-A and -C were located mainly in the cytoplasm of tumour cells: 68.6% (34/51) and 62.8% (32/51) positive for VEGF-A and VEGF-C. VEGF-C expression was more frequent in tumours of the deceased patients [88.2% (15/17)] compared to that in the survivors [47.0% (16/34)]. Quantitative VEGF-C levels in the deceased patients were 0.304+/-0.023, which was significantly elevated compared to that in the survivors (0.131+/-0.018) (p<0.01). The frequency of VEGF-C expression was higher in patients with lymph node metastases (80.0%, 28/35) compared to those with negative nodes (25%, 4/16). Accordingly, its levels were markedly elevated in the former (0.230+/-0.017) than in the latter (0.089+/-0.011) (p<0.01). Furthermore, tumour cell invasion into the enlarged lymphatic vessels was also associated with VEGF-C expression. Its expression levels were 0.271+/-0.028 in lymph vessel invasion and 0.153+/-0.021 in the absence of invasion (p<0.01). VEGF-A expression, although correlated with survival, distant metastasis, ascites formation, and blood vessel invasion, was not associate with lymph node metastasis, lymphatic vessel invasion. The expression levels of the two factors were inversely correlated with overall survival rates. It can be conclude that VEGF-C expression in tumour tissues is indicative of lymphatic metastasis, whereas VEGF-A expression is more likely to be associated with haematogenous metastasis. Both VEGF-A and -C could serve as a prognostic biomarker in patients with gastric carcinoma.

[The roles of Helicobacter pylori and pattern of gastritis in the pathogenesis of reflux esophagitis]

OBJECTIVE

Comparing the infection rates and density of Helicobacter pylori (H. pylori) and the patterns of gastritis in reflux esophagitis (RE) and non-erosive reflux disease (NERD) patients to investigate the role of H. pylori in the pathogenesis of RE.

METHODS

Two hundred and twenty-three out-patients with typical gastroesophageal reflux symptoms who consecutively visited the hospital underwent ambulatory 24-hour pH monitoring and gastroscopy, and biopsy of the gastric mucosa. RE and NERD were diagnosed based on the presentation of endoscopy. Gastritis was divided into four different patterns: chronic non-atrophic antritis (CNAA); chronic non-atrophic pan-gastritis (CNAG); chronic atrophic antritis (CAA); and chronic atrophic pan-gastritis (CAG). H. pylori infection was evaluated by Warthin-Starry staining. DeMeester score > or = 15 was considered as pathological acid reflux.

RESULTS

Sixty-two patients (27.8%) were found to have RE, 161 (72.2%) were found to have NERD. Totally, 67 patients had H. pylori infection (30.0%). There was no significant difference in H. pylori infection rate between the RE and NERD groups (25.8% vs. 31.5%, P > 0.05). 45 of the 223 patients were diagnosed as with CNAA (20.2%), 88 (39.5%) with CNAG, 65 (29.2%) with CAA, and 25 (11.2%) with CAG. The CAG rates in the RE and NERD groups were 6.5% and 13.0% respectively (P > 0.05). There were no differences in abnormal pH monitoring rate and DeMeester score among the different patterns of gastritis. In the sixty-seven H. pylori-positive GERD patients, the 24 h pH monitoring positive rate of the moderate-severe H. pylori colonization density group was 46.4%, significantly higher than that of the mild H. pylori colonization density group (73.5%, P < 0.05); and the mean intra-gastric pH value during 24 hours of the moderate-severe H. pylori colonization density group was 2.3 +/- 0.8, significantly higher than that of the mild H. pylori colonization density group (2.0 +/- 1.1, P < 0.05).

CONCLUSION

H. pylori infection is associated with the pattern of gastritis, but shows no relationship to the incidence of RE. High density of H. pylori colonization in gastric corpus may reduce the esophageal acid exposure. Diffuse atrophic gastritis may protect the patients from RE.

[Difference analysis on proteome of Helicobacter pylori in patients with peptic ulcer, gastritis, and gastric cancer]

OBJECTIVE

To identify the different proteins of Helicobacter pylori (H. pylori) in gastric cancer, peptic ulcer, and gastritis initially.

METHODS

H. pylori in the endoscopic biopsy specimens of gastric mucosa of patients with gastric cancer, peptic ulcer, or gastritis, 3 specimens for each disease, were separated and cultured. The whole-cell protein of the H. pylori was extracted by lysis buffer and sonication. The protein concentration of the bacteria cell lysates was measured by the Bradford method. The protein maps of H. pylori were obtained by two-dimensional gel electrophoresis (2-DE) and the different proteins in gastric cancer, peptic ulcer and gastritis were analyzed by Image Master v 5.0. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and electrospray ionization quadrupole time-of-flight mass spectrometry (ESI-Q-TOF-MS) were performed to identify the different proteins. The differential proteins were searched by the Mascot database at www.matrixscience.com.

RESULTS

Four protein spots of H. pylori were over-expressed in the protein maps from gastric cancer in comparison with those from peptic ulcer and gastritis. Mass identification showed that the 4 proteins were thioredoxin, adenylate kinase, single-stranded DNA-binding protein, and ribosomal protein 50S L7/L12, with the Mowse scores of 94, 286, 139 and 132, and with the sequence coverage rates of 77%, 33%, 33%, and 28% respectively.

CONCLUSION

Anti-oxidant and inhibiting apoptosis, thioredoxin may be related to gastric carcinogenesis induced by H. pylori. Proteomics technology has a widespread perspective in the field of relationship between pathogenic bacteria and gastric cancer.

Comparative evaluation of microvessel density determined by CD34 or CD105 in benign and malignant gastric lesions

Microvessel density (MVD) is regarded as a surrogate marker for angiogenesis and has been used for tumor prognosis. In this study, MVD was identified immunohistochemically by monoclonal antibodies against CD105 and CD34 in the tissues representing gastric carcinoma, chronic gastritis, and hyperplastic polyps, and the results were correlated with clinicopathologic features. The expression of CD105 in the microvessels within benign lesions was barely visible, and MVD was markedly lower than that determined by CD34. CD34 was strongly expressed in the microvessels within hyperplastic polyps and tissues with gastritis. In gastric carcinoma, CD105 expression in microvessels was as high as the MVD, compared with benign lesions. CD105 stained well-formed mature and newly formed immature vessels within the cancer mass. Correlation analysis showed that MVD determined by CD105 correlated with blood vessel invasion, distant metastasis, and formation of ascites. Survival analysis demonstrated an inverse correlation between MVD count and overall survival: patients with MVD counts of 32 or higher survived for a much shorter time than those with counts lower than 32. Multivariate analysis confirmed that MVD determined by CD105 was an independent prognostic factor for survival. Microvessel density determined by CD34 inversely correlated with overall survival, but it did not correlate with other clinicopathologic parameters except formation of ascites. In conclusion, CD34 was universally expressed in blood vessels within benign and malignant tissues, whereas CD105 expression was minimal in benign tissues but stronger in gastric carcinoma. These data suggest that both CD105 and CD34 could be used for quantification of angiogenesis, but preference should be given to CD105 in the evaluation of prognosis in gastric carcinoma.

[The application of high-resolution endoscopy in non-erosive reflux disease]

OBJECTIVES

To establish the diagnosis standards of the non-erosive reflux disease (NERD) using high-resolution endoscopy. The diagnostic standards are established by observing the evolution of main endoscopic appearance of NERD with high-resolution endoscopy, in conjunction with 24 h monitoring of the pH and proton-pump inhibitor experiments.

METHODS

Patients with gastroesophageal reflux disease symptoms and healthy volunteers were enrolled. All the individuals were assessed with high-resolution endoscopy and 24 h ambulatory pH monitoring. Patients with negative 24 h ambulatory pH monitoring or with positive 24 h ambulatory pH monitoring but negative endoscopic appearance were undertaken proton-pump inhibitor test.

RESULTS

The individuals were divided into 3 groups: 19 in erosive esophagitis, 62 in non-erosive group, and 24 were healthy volunteers. The shapes of Z-lines are divided into 6 types: sharply circle, sparsely serration, serration, tattered, triangular extension and lingulate extension. The percentage of each type in non-erosive group was 6.5%, 6.5%, 6.5%, 11.2%, 61.2%, and 8.1% respectively. The percentage of sharply circle, sparsely serration and triangular extension Z-lines were 25.0%, 58.3% and 16.7% respectively in the control group. There were more serration, fractured, triangular extension, and tongue-like extension Z-lines in the non-erosive group than in the control group. The difference was significant (P < 0.05). The appearance of the cardia membrane below the Z-line was categorized into four types: flatted, rough, concavo-convex and villiform. In the control group, the percentage of flatted, rough and concavo-convex types were 16.6%, 54.2%, and 29.2% respectively. In the non-erosive group, cardia membrane of rough, concavo-convex and villiform shapes were 16.1%, 9.7%, and 74.2% respectively. There were more shapes of villiform types in the non-erosive group than in the control group. The difference was significant (P < 0.05). The sensitivity and specificity of high resolution endoscopic test in diagnosing NERD was 77.8% and 6/8 respectively.

CONCLUSIONS

High resolution endoscopic test will raise the diagnostic rate of NERD. NERD was divided into non-erosive esophagitis and symptomatic gastroesophageal reflux disease.

H. pylori genotypes and cytokine gene polymorphisms influence the development of gastric intestinal metaplasia in a Chinese population

BACKGROUND

Cytokine gene polymorphisms and Helicobacter pylori (HP) genotypes have been linked to gastric cancer development in Western countries. We determined the role of host cytokine polymorphisms and bacterial virulent factors in the development of gastric intestinal metaplasia (IM) in a Chinese population with a high background gastric cancer incidence.

METHODS

Three hundred two HP-infected noncancer individuals living in Shandong province of China with available DNA were studied. Polymorphisms in different loci of inflammatory cytokines Interleukin IL-1B, IL-1RN, Interleukin IL-8, IL-10, IL-18, tumor necrosis factor-A (TNF-A), and Transforming growth factor (TGF-B), were determined by allelic discriminating TaqMan polymerase chain reaction (PCR) or a variable number of tandem repeats. Presence of HP virulence factors in cagA, vacA, and babA2 were determined by PCR. Baseline gastric biopsies were assessed for the presence of IM.

RESULTS

Among HP-infected subjects, carriers of the IL-1B-511 T allele were associated with a modestly greater prevalence of IM (adjusted OR 2.0, 95% CI 1.0-3.7). There was no association between the presence of IM and polymorphisms in other inflammatory cytokines. Although most subjects from this region harbored the virulent HP strains, carriage of the vacA m1 strain was associated with a significantly higher prevalence of IM (adjusted OR 1.8, 1.1-3.0). The presence of both host (IL-1B-511 T) and HP (vacA m1) genotypes further increased the risk of IM (OR 5.7, 2.0-16) when compared with individuals with the low-risk genotype.

CONCLUSION

The carriage of proinflammatory IL-1B-511 and HP vacA m1 genotypes was associated with the development of gastric IM in the Chinese.

[Anxiety and depression related to the symptoms of gastroesophageal reflux disease]

OBJECTIVE

To compare the differences in the psychological scale scoring among different subgroups reflux esophagitis (RE) and non-erosive reflux disease (NERD) and to explore the influence of mental factors on the pathogenesis of RE and NERD.

METHODS

Two hundred and six patients with typical heartburn and acid regurgitation underwent endoscopy and esophageal pH monitoring and then were divided into 4 groups: RE+ group (n = 35, 24.3%) with RE and positive pH monitoring results, RH- group (n = 15, 30.0%) with RE and negative pH monitoring results, NERD+ group (n = 77, 40%), with NERD and positive pH monitoring results, and NERD- group (n = 79, 50.6%) with NERD and negative pH monitoring results that was re-divided into 2 subgroups according to the symptom index (SI): NERD-SI+ group (n = 18, 22.8%) with positive symptom index and NERD-SI- group (n = 61, 77.2%) with negative SI. The demographic data and body mass index (BMI) were investigated. The psychological questionnaires: Symptom Checklist 90 (SCL-90), and Hospital Anxiety and Depression Scale (HAD) were used.

RESULTS

(1) Male patients were dominant in the RE group and RE+ subgroup, while female patients were dominant in the NERD group and NERD+ subgroup. The values of BMI of the RE group and RE+ subgroup were significantly higher than those of the NERD group and NERD+ subgroup. (2) The abnormal pH monitoring rate of the RE group was 70.0%, significantly higher than that of the NERD group (49.4%). The average DeMeester's score of the RE group was 39.3 (96.5), significantly higher than that of the NERD group 13.8 (33.6). The average DeMeester's score of the RE+ group was 68.1 (95.2), significantly higher than that of the NERD+ group 40.1 (64.4). (3) 44.6% (29/65) of the patients presented depression and 36.9% (24/65) had anxiety, most of them were in mild or moderate degree. The scores of most items of each mental scale were significantly higher in the NERD- patients than in the NERD+ patients, especially in the NERD-SI- subgroup.

CONCLUSION

The symptoms of RE+ and NERD+ patients are associated with esophageal acid exposure and the acid reflux in the RE patients is much severer than that in the NERD patients. Anxiety and depression are related to the symptoms of patients without objective evidence of esophageal mucosal injury and acid reflux (NERD-), especially in the symptom index negative subgroup. Visceral hypersensitivity and stress play an important role in the pathogenesis of gastroesophageal reflux.