[Correlation between Campylobacter pylori and chronic atrophic gastritis]

The correlation between urease activity of Campylobacter pylori and atrophic gastritis was studied. On the basis of fundamental study on the optimal pH of C. pylori urease activity, urease activity of 38 biopsied specimens were measured under pH 5 condition, and compared with the positive ratio of C. pylori. In this study, sensitivity was 86.7%, and specificity was 87.0%, respectively. Mean urease activity of C. pylori positive specimens was 3.69 mIU/mg protein, and under this condition, C. pylori was likely to produce ammonia of 0.0218 mumole per minute, enough to damage the gastric mucosa. In addition, there was encountered high urease activity in the specimens which showed moderate glandular atrophy and severe mucosal inflammation. In conclusion, urea-urease-NH3 sequence is most likely to have some association with gastric glandular atrophy.

Helicobacter pylori: bridging the credibility gap

In summary, therefore, there are interesting associations between H pylori, duodenal ulcer, and non-ulcer dyspepsia. In type B gastritis there may be enough evidence to suggest a causal role. The relation between gastritis and upper gastrointestinal symptomatology, however, remains contentious. The relation between H pylori and acid secretion may be more intimate than was previously thought. 'Pylorites' must temper their enthusiasm and provide hard data; 'Schwartzians' must broaden their horizons.

Peritonitis caused by Campylobacter jejuni and serologically confirmed in a patient being treated with continuous ambulatory peritoneal dialysis

A case of Campylobacter jejuni peritonitis in a patient being treated with continuous ambulatory peritoneal dialysis is described. The significance of the organism isolated from our patient was initially doubtful because of a rapid defervescence of symptoms with minimal specific antibiotic therapy, lack of a preceding diarrhoeal illness and the time taken to isolate and identify the organism. Serial serum IgM, IgA and IgG antibody estimations clearly showed an acute seroconversion confirming that the strain of C. jejuni isolated was the causative organism in this case.

[The serotype distribution of Campylobacter jejuni strains among gastroenteritis in hospitals over 7 year period in Tokyo]

Campylobacter jejuni strains isolated from gastroenteritis at 4 general hospitals of Tokyo Metropolitan during the period from 1981 to 1987 were serotype according to the slide agglutination test (TCK system) developed by the Tokyo Metropolitan Research Laboratory of Public Health. Two thousand four hundred seventy-nine strains isolated from sporadic cases among infants and children, 1,962 (78.5%) were typed by 33 typing sera numbered TCK 1 through TCK 33 and leaving 537 strains (21.5%) untypable. Out of the typable strains, 1,643 strains reacted with only single serum, while 319 strains reacted with 2 or more antisera. The most common serogroups included TCK 21, 20, 7, 1, 4, 23, 24, 10, 30 and 12. Out of the 1,250 strains isolated from sporadic cases among adults, 974 strains (77.9%) were typed and 276 strains were untypable. The most common serogroups were similar to those of infants and children. Serogroups TCK 1, 7, 4 and 21 were consistently the common serogroups every year during the 7 year study. Isolation frequency of serogroup TCK 30 have increased remarkably since 1986, while TCK 23, 14 and 9 have decreased.

[Clinical study on norfloxacin in pediatrics]

Pediatric infections were treated with norfloxacin (NFLX), a pyridonecarboxylic acid antibiotic developed by Kyorin Co., Ltd., to investigate its clinical efficacy. 1. Thirteen patients were treated with NFLX. These patients included of 5 with Campylobacter enteritis, 4 with Salmonella enteritis, 3 with dysentery and 1 with acute enteritis. 2. Of 14 pathogens identified, complete eradications were observed with 13 strains and partial eradication was seen in 1 case. Thus, overall eradication rate was 92.9%. 3. These were no symptoms nor abnormal laboratory findings which indicated an occurrence of side effect due to the NFLX treatment.

Cardiovascular and bacteremic manifestations of Campylobacter fetus infection: case report and review

A case of bacteremia due to Campylobacter fetus subspecies fetus with concomitant pleuropericarditis in a previously healthy patient is presented. The organism is ubiquitous, but most commonly causes infection in patients with chronic underlying illnesses. The pathogenesis of human infection has not been definitively elucidated. Bacteremia is the most common clinical manifestation of this infection, although cases of thrombophlebitis, mycotic aneurysm, endocarditis, and pericarditis have also been reported. The treatment of choice for most infections is gentamicin, with chloramphenicol recommended for infection involving the central nervous system. Tetracyclines and erythromycin are alternative agents. Prolonged therapy is essential to the prevention of relapse. A high index of suspicion is necessary for the recognition of this organism in the appropriate clinical settings.

[Campylobacter pylori in patients with gastroduodenal disease]

Recent advances of Campylobacter pylori (C. pylori) in human gastric disease and peptic ulcer were reviewed. C. pylori is a microaerophilic, motile, gram negative spiral rod bacterium. And all strains of C. pylori has a strong urease activity. In our experience. 91% of duodenal ulcer, 88% of gastric ulcer and 43% of control have C. pylori associated gastric mucosa. Patients of peptic ulcer with C. pylori infection were high relapse than patients of peptic ulcer without C. pylori, C. pylori is now known to be the most common and important case of pathologic gastritis, and C. pylori infection have been associated with gastric ulcer, duodenal ulcer, and non-ulcer dyspepsia. Although it has been only possible to culture C. pylori for about 6 yr in Japan, there are already sufficient data available to allow us to develop the basic framework that relates C. pylori gastritis to the causation of peptic ulcer disease.

Helicobacter (= Campylobacter) pylori in Africa

Epigastric pain is a common complaint throughout Africa, mostly in the form of non-ulcer dyspepsia. It has recently been suggested that Helicobacter (= Campylobacter) pylori, a bacterium that colonizes the gastric mucosa and causes type B gastritis, may be the cause of this epigastric pain. This paper reports the endoscopic, histological and bacteriological findings in 57 patients presenting with epigastric pain to the University of Maiduguri teaching hospital during one year, together with a review of the African literature. Of 57 patients, 49 had non-ulcer dyspepsia, 7 peptic ulceration and 1 carcinoma of the stomach. 93% of the patients had histological gastritis, and of these 87% were colonized with H. pylori. The bacterium was cultured from 13 patients. This high prevalence of gastritis and H. pylori has been found throughout Africa. The figures support a causative role for H. pylori in histological gastritis. At present the evidence in support of a causative role in non-ulcer dyspepsia is not strong enough to be able to recommend the routine use of anti-H. pylori therapy in patients with epigastric pain.

Gastric campylobacter-like organisms and active antral gastritis in Puerto Rico

We attempted to verify if the reported association of gastric campylobacter like organisms (GCLO) with active antral gastritis holds true in our population. All patients undergoing elective upper endoscopy were eligible for the study unless they had a history of gastric cancer or previous antrectomy. Biopsy specimens from 100 consecutive patients were examined blindly for the presence of inflammatory activity and/or intestinal metaplasia. The presence of GCLO was determined by the acridine orange fluorescence technique. A total of 131 antral biopsies examined were classified as either normal, active gastritis, chronic gastritis with activity and chronic gastritis without activity. GCLO were identified in 84% of the biopsies with inflammatory activity (active gastritis and chronic gastritis with activity). However, GCLO were found only in 11% of those biopsies with chronic gastritis without activity. It is therefore our conclusion that the previously reported association of GCLO with active gastritis holds true for our population.

[A case of right-sided infective endocarditis in a drug addict]

A 49-year-old man was admitted to Mitsui Memorial Hospital because of fever of unknown origin. Since one year ago, he had often used intravenous narcotic drugs. Ten months before his admission, he had his first experience of fever and a chill. Four months later, he was admitted to a hospital under the diagnosis of pneumonia and he was treated successfully. After his discharge, he began to use drugs again, which resulted in the repetition of fever and chills during four months prior to his admission to our hospital. On admission, physical findings concerning the patient were unremarkable, except for mild hepatomegaly. ECG and chest X-ray were normal. Laboratory data revealed marked inflammatory changes and severe liver injury. Blood culture disclosed Campylobacter fetus and two dimensional echocardiography showed a large vegetation on the anterior tricuspid valve. He was diagnosed as isolated tricuspid infective endocarditis accompanied with acute hepatitis due to drug abuse. Moreover pulmonary perfusion scintigraphy showed decreased perfusion in the right lower lung field, which suggested that pneumonia of six months ago was due to septic pulmonary emboli from the infected tricuspid valve. The combined antibiotics therapy was successful. By the follow-up echocardiographic studies, the size of vegetation was observed to decrease progressively.

Helicobacter pylori: controversies and an approach to management

Helicobacter pylori (formerly, Campylobacter pylori) is a gram-negative, spiral-shaped bacterium with a strong affinity for gastric-type epithelium. Convincing evidence indicates that H. pylori plays an etiologic role in the development of chronic, nonspecific gastritis, and it may play an important role in the pathogenesis of duodenal ulcer disease. An etiologic role for this organism in chronic gastric ulceration, nonulcer dyspepsia, and gastric carcinoma is not established. Whereas the diagnosis of H. pylori infection is relatively straightforward, the questions of when and how to treat the infection do not have established answers. A high rate of recrudescence follows most currently used therapeutic interventions. Until the pathogenicity of H. pylori in clinical disease is further supported and additional treatment trials have been completed, a conservative management approach is recommended.

[Evaluation of effectiveness of rokitamycin dry syrup in acute enteritis in pediatrics. A comparative study on rokitamycin and fosfomycin dry syrups]

Because Campylobacter jejuni is most frequently identified as a causative organism of bacterial enteritis in pediatrics, a study was done to evaluate the clinical efficacy against Campylobacter enteritis and the safety of a macrolide antibiotic, rokitamycin (RKM). In case of acute enteritis, RKM was used in a form of dry syrup at a dose level of approximately 30 mg (in potency)/kg body weight and its efficacy and safety were compared to those of fosfomycin (FOM) dry syrup which is currently in use at a dose level of 60 mg (in potency)/kg. Both drugs were administered, as a rule, in 3 divided daily dose (RKM before meal and FOM after meal) for 5 consecutive days. Comparisons of the drugs were made using a well-controlled method. Obtained results are summarized as follows. 1. No significant differences in background factors of the 2 drug groups were apparent, hence it was deemed that no obstacles existed in making comparative studies of the 2 groups with regard to their efficacies and safeties. 2. Overall efficacy rate against Campylobacter enteritis was 100% in the RKM group with a rate of excellent efficacy of 91.3% and the former was 94.4% in the FOM group with the latter of 72.2%. Though the RKM group apparently showed higher rates by 5.6% and 19.1%, respectively, for overall and excellent efficacies, they were not statistically significant as both drugs showed good efficacies. When acute cases of enteritis other than those caused by Campylobacter were included in the analysis, overall efficacy rates and rates of excellent efficacy were, respectively, 97.6% and 85.7% for the RKM group and 88.6% and 68.2% for the FOM group, thus RKM showed higher efficacy rates by 9.0% and 17.5%, respectively. These differences were deemed statistically significant using the U-test. 3. Numbers of days required for most of the major symptoms to subside were 3 days or less for the group for which RKM was used against Campylobacter enteritis. Similar results were observed for the FOM group also. In cases of acute enteritis due to other causes than Campylobacter, slower recoveries were observed for both the RKM and the FOM groups than in Campylobacter enteritis cases, with the latter group slower than the former. In cases of puruloid stool, the recovery in the RKM group was significantly faster by U-test than the FOM group, and a similar trend was observed overall. 4. Bacteriologically, the eradication rate of Campylobacter in the RKM group was very good at 91.3% with the FOM group showing a rate of 78.9%.(ABSTRACT TRUNCATED AT 400 WORDS)

[Morphology of chronic gastritis associated with Campylobacter pylori infection]

Recently, a close relation has been found between infection of the gastric mucosa by Campylobacter pylori and chronic gastritis. To establish the possible existence of characteristic morphologic changes in this disease, which can be differentiated from other unrelated forms of gastritis, we analyzed the antral biopsies obtained from 75 patients, 35 with duodenal peptic ulcer and 40 with nonulcerous dyspepsia. The diagnosis of C. pylori infection is based on positive biopsy culture or, if not, when following three requirements are met: positive urease test before 24 hours, identification of the germ by Gram stain and visualization in the tissue of microorganisms with morphology similar to that of C. pylori. We found that 85.5% of the 55 patients with C. pylori infection present active chronic gastritis with lymphoid nodes (GCA + NL), while this morphology is only found in 5 of the 20 uninfected patients. The association of GCA + NL with C. pylori infection is highly significant (p less than 0.0001). We think that it could be a local immunologic response to the stimulus of the bacterial antigen, and that it has sufficient morphologic entity to differentiate it from other inflammatory processes of the gastric mucosa of still unknown etiology.

[Campylobacter pylori and diseases of the stomach]

In spite of extensive clinical studies the pathogenicity of Campylobacter pylori in various diseases of the stomach is still not fully elucidated. In peptic ulcer Campylobacter pylori has not provided a reasonable explanation for the localized and solitary development of ulcer lesion which is one of characteristic features of this clinical entity. Our previous clinical study revealed that relapse occurs mostly at or near the scar of the preceding ulcer lesion and occurs more often in red scar than in white scar in peptic ulcer. Therefore, the scar was chosen to investigate whether there is a correlation between Campylobacter pylori and relapse. Twenty patients with healed gastric ulcer were biopsied in duplicate at 4 different sites, namely at the center of and near the scar of the preceding ulcer lesion, in the body and pyloric antrum. One of the duplicate specimen was stained, and the other cultured. Number of the colony observed on the plate was highest at the scar center followed by near the scar or in the body, and the pyloric antrum showed the lowest. Campylobacter pylori was detected in 46.7% of red scar, and 20% of white scar. Campylobacter pylori may play a pathogenic role in some patients of peptic ulcer, but not in all. Namely Campylobacter pylori is one of factors which may cause in imbalance between offensive and defensive powers at gastric mucosa and may lead to development of ulcer lesion. In case of positive bacteriological test, therefore, as to presence of Campylobacter pylori, the preventive measure for relapse such as bismuth preparation may be considered.

[Comparative study of the effect of wei-yan-ning and furazolidone in the treatment of gastritis and gastric ulcer caused by pyloric Campylobacter]

Wei-Yan-Ning and Furazolidone were used separately in the treatment of 62 cases of gastritis and gastric ulcer caused by pyloric campylobacteria. The examinations one month later proved, through the gastrofiberscopy and pathological test as well as the urease test, that, among the 40 cases of Wei-Yan-Ning group, there were 25 cures (62.5%), prominent effect for 9 cases (22.5%), improvement for 3 cases (7.5%). The total effective rate was 92.5%. Among the 22 cases of the Furazolidone group, there were 7 cures (31.8%), prominent effect for 5 cases (22.7%), improvement for 4 cases (18.2%). The total effective rate was 72.7%. As for the improvement of symptom, the average time for the Wei-Yan-Ning group was 12.5 +/- 8.12 days; and the Furazolidone group was 21.63 +/- 7.87 days. Therefore, the effect of Wei-Yan-Ning group was superior to that of the Furazolidone group (P less than 0.05).