Serum Group I pepsinogens in children with recurrent abdominal pain

Recurrent abdominal pain (RAP) is a common, frustrating problem in childhood. A commonly mentioned cause has been acid hypersecretion without evidence of actual ulceration. Recently, a radioimmunoassay specific for group I pepsinogens (PgI), one of two immunochemically distinct groups of human pepsinogens or precursor zymogens of pepsin, has been developed. Serum PgI levels have been demonstrated to reflect the acid secretory capacity of gastric mucosa, specifically the maximal and peak acid outputs (MAO, PAO), as well as the basal acid output (BAO), thus providing an accurate, tubeless determination of acid secretion. The present study of children with and without RAP has revealed no significant difference in serum PgI levels in these groups. These results suggest that acid hypersecretion cannot be demonstrated in RAP: therefore its relationship to RAP is questionable.

Observations on plasma gastrin and plasma pepsinogen in relation to weaning and gastric (pars oesophagea) ulceration in pigs

Plasma gastrin and pepsinogen were measured at weekly intervals in 38 pigs from weaning at about four weeks of age until slaughter at 24 weeks. Plasma gastrin was 104 +/- 6.2, 85 +/- 11.2, 126 +/- 11.67 mol per litre in the pigs aged four, five and six weeks and 43 +/- 2.57, 31 +/- 2.29, 17 +/- 0.87 mol per litre when they were 21, 22 and 23 weeks old. Sixteen of the pigs had apparently normal stomachs, the remainder had some degree of epithelial hyperplasia and, or, ulceration of the pars oesophagea of the stomach. No differences were detected between plasma gastrin and plasma pepsinogen in pigs with normal stomachs and those showing evidence of epithelial hyperplasia or ulceration of the pars oesophagea. If ulcers of this region arise from hypersecretion of gastric acid some factor(s) other than gastrin appear to be involved. The possibility is discussed that the progressive decline in plasma gastrin is part of the maturation process.

Ulcer healing and serum pepsinogen I in cimetidine and glycopyrrolate treated duodenal ulcer patients

Cimetidine is effective in the treatment of acute duodenal ulcers. 26 endoscopically verified duodenal ulcer patients were treated for four weeks with either cimetidine 0.8 g/day or with the anticholinergic drug glycopyrrolate 4 mg/day on a double-blind basis. Gastroscopical healing was achieved in 10/13 (77%) of cimetidine treated patients and in 4/13 (31%) of glycopyrrolate treated patients (p less than 0.05). There were no major side-effects in either group. In this study cimetidine seemed to be more effective than glycopyrrolate in the treatment of acute duodenal ulcer. The pretreatment level of serum pepsinogen I was elevated (110.1 +/- 42.8 microgram/l; mean +/- SD) in these patients (normal range 20--100 microgram/l) and increased significantly after pentagastrin stimulation to 133.2 +/- 56.4 microgram/l (p less than 0.001). The post-treatment level measured 24 hours after termination of treatment had increased significantly in the cimetidine group but not in the glycopyrrolate group. In the cimetidine group the high pretreatment level of pepsinogen I tended to predict a poor response.

[Mechanisms stabilizing the concentration of intestinal gland hydrolases in peripheral blood]

The blood content of the enzymes changes under narcosis. The atrophic alterations of the pancreas induced by ligation of its ducts, entail the reduction of the pancreatic enzymes content in the blood. This leads to an increase of the amylase and pepsinogen affinity with the blood plasma proteins participating in the transport of enzymes. In uremia disturbing the fermental homeostasis, the transport properties of proteins and erythrocytes change. Duodenectomy exerts no persistent or obvious effect on the content of pepsinogen, amylase, trypsin and its inhibitor in the peripheral blood plasma and temporarily reduces its lipolytic activity.

Effects of two consecutive experimental Haemonchus contortus infections on abomasal pepsin and electrolytes and serum pepsinogen and electrolytes of sheep

Pepsinogen, sodium, potassium and chloride concentrations in blood, and pepsin, pH and ionic concentrations in abomasal contents were measured in 4 lambs each fitted with a permanent abomasal cannula infected with 25 000 H. contortus larvae at intervals of 39 days. No significant change in blood sodium, potassium and chloride concentrations occurred after infections while the pepsinogen level increased rapidly to reaching a maximum (600% of control) 7-8 days after infection. This increase was associated with a rise in abomasal pepsin secretion, the pepsin concentration in the contents rising from 7210 to 9220 mU of tyrosine during the same period. This period was characterized by a significant (P less than 0.01) increase in abomasal pH and Na+ concentration whereas the K+ and Cl- concentrations were significantly (P less than 0.01) reduced. The second infection was associated with similar abomasal ionic changes but of shorter duration. It is likely that the second infection transiently stimulated the egg-aying of the adult worms of the first infection. Twenty one days after the re-infection the number of adult worms remaining was very low (139 +/- 41) and is considered as an effect of the "self-cure" phenomenon.

Serum pepsinogen I as a predictor of stomach cancer

Among 7498 Japanese men who were examined from 1967 to 1970, 48 were subsequently diagnosed with stomach cancer and had premorbid stored sera available for serum pepsinogen I analysis. The median interval between serum collection and diagnosis of cancer was 44.5 months (range, 3 to 103 months). A low pepsinogen I level was found in 15 of the 48 patients with stomach cancer and in only six (6.3%) of 96 matched control subjects (p < 0.001). All 15 patients with low pepsinogen I levels belonged to the subgroup of 38 who had the intestinal-mixed-other histologic types of gastric cancer. This finding indicates that a low serum pepsinogen I level is a subclinical marker of increased risk for these histologic types of gastric cancer.

[The natural pattern of Ostertagia-infections in cattle (author's transl)]

In experiments carried out under field conditions with calves reared free from parasites and kept on pastures contaminated with Ostertagia larvae, the natural pattern of infestation with this parasite in calves was studied. It was shown that calves turned out early (late in April) developed a much higher primary (overwintered) infestation than calves turned out six weeks later on mown pasture. During the grazing season the serum pepsinogen levels were more indicative of the severity of the infestation than was the egg output. There also was a correlation between the serum pepsinogen level and loss of weight. During the housing period following the first grazing season, adult worms were eliminated more rapidly than inhibited fourth-stage larvae, resulting in a worm population consisting of up to 90 per cent EL-4 at the end of the housing period in April.

Serum pepsinogen I and gastrin in relation to extent and location of intestinal metaplasia in the surgically resected stomach

A study of 177 patients undergoing distal subtotal gastrectomy indicates that a preoperative serum pepsinogen I (PGI) level below 20 ng/ml predicts the presence of gastic carcinoma and the degree of intestinal metaplasia of the gastric antrum. The serum gastrin level was not predictive of carcinoma or of the degree of intestinal metaplasia. Of the 15 patients with a low serum PG level, 13 had carcinoma and 2 had atypical polyps. The PG I level in a stored serum sample from 4 of 30 patients fell from normal to abnormal over a period of 8-9 years. Each of these converters had invasive carcinoma of the stomach. This suggests that persons showing a fall in serum PG I to abnormal levels during serial analyses should be evaluated for the possibility of gastric carcinoma.

Serum group I pepsinogens in children

Serum group I pepsinogens (PG I) were determined by a radioimmunoassay method in blood drawn from premature and newborn infants, children of various ages, a control group of young healthy adults, and a group of women at delivery. Very low concentrations of PG I were found in blood of prematures and newborns, and there was no correlation between serum PG I in women at delivery and their newborn full-term infants. Serum PG I rose abruptly during the early months of life, but remained significantly reduced up to the age of 10 years. These findings are in agreement with those reports showing an increasing pepsin secretion during childhood, and thus indirectly lend support to the use of serum PG I as an estimate of gastric pepsin secretion.

The effect of insulin-induced hypoglycaemia on serum group I pepsinogens, serum gastrin, and plasma secretin and on gastric H+ and pepsin outputs

The effect of insulin-induced hypoglycaemia on serum group I pepsinogens (PG I), serum gastrin, and plasma secretin, and on gastric H+ and pepsin secretion was studied on 2 consecutive days in six healthy male students. The hypoglycaemia elicited a significant rise in serum PG I on both days. Furthermore, an increase in basal serum PG I was noted from the first to the second day, with a further increase the third day. Serum gastrin, which was not significantly affected, nevertheless tended to peak immediately after the nadir of the blood glucose value. Plasma secretin, on the other hand, fell significantly during gastric suction before the injection of insulin on the second day and non-significantly on the first day. A further declining tendency in plasma secretin was observed after insulin injection. Gastric H+ and pepsin outputs increased significantly on both days. There was no significant difference in gastric H+ response on the 2 days, whereas peak gastric pepsin output was significantly reduced on the second day. It is concluded that the rise in serum PG I probably reflects an increased synthesis of pepsinogens and that the fall in peak gastric pepsin output on the second day may reflect reduced storage of pepsinogens in the chief cells.

Physiological abnormalities in duodenal ulcer: a brief review

Patients with duodenal ulcer may have one or more of the following abnormalities: (1) larger than normal volume of gastric mucosa containing correspondingly more acid and pepsin secreting cells which is reflected in (2) increased mean concentration of pepsinogen-I in plasma, and (3) increased maximal rates of secretion of acid and pepsin in response to stimuli such as histamine, gastrin, insulin, or food; (4) increased sensitivy to stimulation by gastrin as reflected by decreased dose of gastrin needed to evoke half maximal response; (5) increased gastrin response to meals; (6) decreased inhibition of gastrin release and of acid secretion in response to acidification of the gastric contents; and (7) increased rapidity of gastric emptying. Items 2, 5, and 7 are heritable autosomal dominant traits in at least some patients. Although mean values of each of these 7 items are significantly different from normal, the range is wide and most individual duodenal ulcer patients fall within the normal range. The diversity of physiological abnormalities found in patients with duodenal ulcer shows that it is a heterogeneous disease with many different factors operating in its pathogenesis.

Use of a monthly health review to ascertain illness and injuries

A Monthly Health Review was developed to monitor symptoms, illnesses and injuries among Air Traffic Controllers. Return rate of the mailed check-list exceeded 90 per cent. Diagnoses were generated from symptom clusters by computer algorithms. Telephone interview by physicians, laboratory analyses for serum pepsinogen I, and analyses of relations between symptom clusters and degree of disability all served to support the validity of the methodology. Such a system can provide inexpensive surveillance of morbidity in suitable populations.

The effect of secretin on serum group I pepsinogens (PG I) in man

Six healthy young males were studied with an intravenous infusion of secretin, 2 CU/kg body weight and hour in saline, or with saline alone for 3 h on two separate days. Blood was drawn before and at regular intervals during the infusions, and serum PG I was determined by radioimmunoassay. After an initial decline on both days, serum PG I rose significantly during the secretin infusion. The initial fall in serum PG I was probably not caused by heparin used to keep the indwelling catheter open, since a similar fall was also observed in another six subjects in whom saline was used to keep the catheter open. Moreover, heparin added to the serum did not affect the measurement of PG I.

The effect of a test meal on serum group I pepsinogens (PG I) and serum gastrin in persons with normal gastric H+ secretion and in persons with achlorhydria

Thirteen persons with normal pentagastrin-stimulated gastric H+ secretion and 17 with achlorhydria were studied with a liquid test meal after an overnight fast. Blood was drawn before and every 30 min for 180 min after start of the meal. Serum gastrin, serum PG I, and serum vitamin B12 were determined by radioassay methods. Serum PG I was significantly lower in the achlorhydric subjects than in the normal secretors. The meal induced a slight and late rise in serum PG I in the control group. In contrast, the meal caused a slight fall in the achlorhydric persons. Basal serum gastrin was significantly higher in the achlorhydric group, in whom the meal also caused a significant fall in serum gastrin, which contrasts sharply with the rise in the control group. Although serum gastrin fell significantly in the achlorhydric group, a meal-induced rise in serum gastrin was observed in some of the achlorhydric subjects with basal serum gastrin below 100 pmol/l. Serum vitamin B12 was reduced in 8 of the 17 persons with achlorhydria, and in these 8 subjects serum PG I was significantly lower than in those with achlorhydria and normal serum vitamin B12.

The effect of somatostatin on serum group I pepsinogens (PG I), serum gastrin, and gastric H+ and pepsin secretion in man

Six healthy young males were studied with an intravenous infusion of saline for 1 h, followed by somatostatin, 100 microgram/h, for 2 h, and thereafter by another 2 h with saline infusion. Gastric H+ and pepsin outputs were determined in 30-min periods throughout the study. Blood was drawn at regular intervals, and blood glucose was determined by a hexokinase method. PG I and gastrin in serum were determined by radioimmunoassay methods. Gastric H+ and pepsin outputs were markedly reduced during the somatostatin infusion and the first 30-min period after cessation of the somatostatin infusion. In the subsequent 60-min period gastric pepsin secretion increased significantly as compared with the basal period, whereas the gastric H+ output only increased non-significantly. Mean serum PG I increased during the somatostatin infusion and remained elevated throughout the study. The rise in serum PG I was marked in five and only marginal in the sixth person. Serum gastrin fell during the somatostation infusion and returned to the basal level thereafter. Blood glucose, on the other hand, fell only during the first 90 min of somatostatin infusion, and then climbed to the basal level, where it stayed for the remaining part of the study. The present results suggest that the pepsinogen synthesis is unaffected by somatostatin, and that serum PG I seems to reflect the amount of pepsinogens stored in the gastric mucosa.

Serum group I pepsinogens during pregnancy

Serum group I pepsinogens (PG I) values were determined by a radioimmunoassay method in blood drawn from women at different times during pregnancy, at delivery, and 4 days after delivery. They were divided into five groups according to sampling time: group I, 0-14 weeks of pregnancy; group II, 15-27 weeks; group III, 28-40 weeks; group IV, at delivery; and group V, 4 days after delivery. No significant difference between the mean serum PG I in the various groups was found, and the mean PG I value in each group was of the same magnitude as previously found in non-pregnant controls. Since serum PG I has been reported to be positively correlated with gastric acid and pepsin secretion, this study suggests that other factors are involved in the apparently reduced occurrence of peptic ulcer during pregnancy.

The effect of a preparturient fenbendazole treatment on lactation yield in dairy cows

Studies carried out on nine farms in north-west England indicated that fenbendazole treatment of adult winter calving dairy cows in the dry period caused an overall increase of 173 kg in their subsequent lactation yield. There was some evidence to suggest that a correlation existed between pasture Ostertagia ostertagi larval burdens and subsequent serum pepsinogen and milk yield responses post treatment. Marked interherd and regional differences existed in the milk yield response to anthelmintic treatment and possible reasons for such results are discussed.