Gastric acidity in older adults

CONTEXT

Early studies suggested that gastric acidity declines as people age. However, sequelae of achlorhydria are uncommon in older people, making this conventional wisdom unlikely.

OBJECTIVE

To ascertain the prevalence of basal gastric acidity and atrophic gastritis (indicated by serum pepsinogen ratio) in older adults.

DESIGN

Cross-sectional study in a volunteer sample.

SETTING

Retirement communities in suburbs of Kansas City, Mo.

SUBJECTS

A total of 248 white male and female volunteers aged 65 years or older living independently.

MAIN OUTCOME MEASURES

Presence of basal unstimulated gastric acid was evaluated noninvasively by having subjects swallow quininium resin. Gastric acid with a pH lower than 3.5 releases quinine, which is then absorbed and excreted into urine. Atrophic gastritis was defined as a ratio of serum pepsinogen I/pepsinogen II of less than 2.9.

RESULTS

Basal unstimulated gastric content was acidic (pH <3.5) in 208 (84%) of 248 elderly subjects. On retesting 66 subjects (35 normals and 31 hyposecretors), 28 (80%) of 35 had pH less than 3.5 both times, and 22 (71%) of 31 had pH of 3.5 or higher twice; in the remaining 16 subjects, low vs high gastric pH changed between tests. Weighted population prevalence estimates in this sample were 67% for consistent acid secretion, 22% for intermittent secretion, and 11% for consistent gastric pH higher than 3.5. Whereas 14 (67%) of 21 consistent hyposecretors had serum pepsinogen ratios of less than 2.9, indicating atrophic gastritis, only 2 (5%) of 44 consistent or intermittent secretors of acid had ratios in this range (P<.001).

CONCLUSIONS

In contrast to what is commonly stated, nearly 90% of elderly people in this study were able to acidify gastric contents, even in the basal, unstimulated state. Of those who were consistent hyposecretors of acid, most had serum markers of atrophic gastritis.

Changes in gastrin and serum pepsinogens in monitoring of Helicobacter pylori response to therapy

The aims of this study in 50 patients with H. pylori infection and duodenal ulcer were to examine the effect of eradication therapy on the serum levels of gastrin, pepsinogen I, and pepsinogen II and to investigate whether monitoring of the serum changes in these peptides after treatment could predict patient outcome. H. pylori status was assessed at entry and one and six months after therapy by culturing and microscopic analysis of the gastric mucosa and by [14C]urea breath test. Significant decreases were observed in the serum levels of gastrin (-11.4 +/- 3%), pepsinogen I (-28.9 +/- 4%), and pepsinogen II (-40.4 +/- 3%) in the 45 patients whose infection was eradicated, but not in the patients without eradication. Serum values of these peptides were unchanged in an additional group of 10 patients that only received omeprazol, none of whom had H. pylori eradicated. The best cutoff point of the percentage of each peptide to predict patient outcome was 10% for gastrin and pepsinogen I, and 15% for pepsinogen II. A pepsinogen II decrease > 15% resulted in the best marker of H. pylori clearance, accurately identifying patient outcome 86.6% of the time, whereas the diagnostic accuracy of gastrin and pepsinogen I was 61.7% and 76.6%, respectively. Significant correlations were found between the bacterial load assessed by histology with the serum concentrations of pepsinogen I and II and with the urease activity as measured by the amount of 14CO2 excreted. In conclusion, eradication of H. pylori infection is followed by a significant drop in serum levels of gastrin, pepsinogen I, and pepsinogen II. Changes in the latter are the most uniform and may be used as an indirect tool to predict treatment outcome.

Efficacy of morantel sustained release trilaminate bolus against gastrointestinal nematodes in grazing dairy calves in Kenya

The efficacy of morantel sustained release trilaminate (MSRT) bolus against gastrointestinal nematodes was evaluated under field conditions over a 10-month period. Twenty weaner calves were randomly divided into 2 groups of 10 calves each and grazed from March to December on adjacent, similarly contaminated paddocks. Group 1 calves (T-1) served as untreated controls while group 2 calves (T-2) were dosed at turnout with MSRT bolus designed to release morantel tartrate continuously for 90 days. The efficacy of MSRT was assessed by comparison of parasitological data (faecal worm egg counts, herbage larval counts, worm counts from tracer calves and set-stocked trial calves, determination of haematological parameters and pepsinogen levels), weight gains and clinical status of the animals. Faecal egg counts from the treated group (T-2) were reduced by 100% (P < 0.001) following treatment and remained significantly (P < 0.05) lower than counts from T-1 calves up to trial termination. The use of MSRT bolus resulted in a reduction of 92% (P < 0.001) in the number of gastrointestinal nematodes in set-stocked calves at the end of the study and a 55 to 85.7% reduction in herbage larval infectivity as reflected in lowered parasite burdens in tracer calves. At the trial termination, the control calves had gained on average (+/- s.d.) 59.4 +/- 4.8 kg (200.0 +/- 7.4 g day-1) and the treated ones on an average 128.6 +/- 10.5 kg (530.0 +/- 13.1 g day-1).

Serum pepsinogen I and gastrin in peptic ulcer patients using nonsteroidal anti-inflammatory drugs

BACKGROUND/AIMS

The inhibition of prostaglandin synthesis induced by nonsteroidal anti-inflammatory drugs (NSAIDs) have very complex effects on the gastric mucosa. They, for instance, inhibit mucosal cell proliferation in gastric ulcer patients. The aim of this study was to investigate whether these effects manifest as changes in pepsinogen I and gastrin concentrations.

METHODOLOGY

Fasting serum pepsinogen I and gastrin samples were collected from 53 consecutive Helicobacter pylori (HP) positive peptic ulcer patients. Ulcer was diagnosed by endoscopy. The presence of HP was determined from the histological specimen taken from the antral mucosa. Histological changes in the gastric mucosa were evaluated according to the Sydney system. A structured personal interview was carried out with all patients at endoscopy, including detailed questions on the daily use of NSAIDs. Patients were divided into two groups according to their use of NSAIDs.

RESULTS

The age-adjusted mean pepsinogen I concentration was significantly lower in patients who used NSAIDs compared to those who did not (91 vs 127 ng/l, p = 0.0035). There was no difference in the mean gastrin concentration between these two groups (91 vs 86 micrograms/l, p = 0.74).

CONCLUSIONS

Serum pepsinogen I concentration was lower in HP positive peptic ulcer patients who used NSAIDs compared to those who did not.

Helicobacter pylori infection and gastric cancer. A nested case-control study in a rural area of Japan

We conducted a seroepidemiological nested case-control study to determine the association of gastric cancer with Helicobacter pylori infection and atrophic gastritis. A cohort of 2858 participants in an annual multiphasic health check-up were followed for eight years. Data for 45 gastric cancer cases and 225 sex-, age-, and address-matched control subjects were analyzed. Helicobacter pylori infection was determined by IgG antibodies, and atrophic gastritis was diagnosed by both serum pepsinogen I level (< or = 70 ng/ml) and the pepsinogen I/II ratio (< or = 3.0). Univariate analysis showed that Helicobacter pylori and atrophic gastritis were significantly associated with gastric cancer. In a multivariate analysis, atrophic gastritis was associated with significantly increased risk of cancer (odds ratio, 3.38; 95% confidence interval, 1.54-7.42); however, Helicobacter pylori was not associated with cancer (odds ratio, 1.84; 95% confidence interval, 0.59-5.72). These results suggest that Helicobacter pylori infection alone is not directly associated with gastric carcinogenesis but has an indirect relation to gastric cancer through the development of atrophic gastritis.

Changes in serum pepsinogen, gastrin, and immunoglobulin G antibody titers in helicobacter pylori-positive gastric ulcer after eradication of infection

There are no studies of changes in immunoglobulin G (IgG) titers to Helicobacter pylori, serum pepsinogen, and gastrin in patients with H. pylori-positive gastric ulcers. We investigated the effect of therapy for H. pylori-positive gastric ulcer on IgG titers to H. pylori, serum pepsinogen I and II, and gastrin. Thirty-six patients with H. pylori-positive gastric ulcer were treated with lansorazole and antibiotics for 2 weeks. Serum pepsinogen I and II concentrations, serum gastrin, and IgG titers to H. pylori were measured before treatment and then at 4 and 12 weeks after stopping the treatment. The presence or eradication of H. pylori was determined using the rapid urease test and by histologic H. pylori staining. For 19 patients in whom H. pylori had been successfully eradicated, the pepsinogen I/II ratio increased, pepsinogen II levels decreased, and the anti-H. pylori IgG decreased compared with the results from before therapy and with those from 4 and 12 weeks after therapy. Gastrin levels decreased compared with pretreatment results and those from 4 weeks after the end of treatment. In 17 patients in whom the therapy failed to eradicate H. pylori infection, there were no sequential significant changes in the pepsinogen I/II ratio or in the levels of pepsinogen I, pepsinogen II, anti-H. pylori IgG, and gastrin. A decrease in the serum levels of the IgG antibody to H. pylori and gastrin and also an increase in the pepsinogen I/II ratio could be used as predictors for the eradication of H. pylori infection in gastric ulcer.

Effects of adult and larval Haemonchus contortus on abomasal secretion

Abomasal pH and serum pepsinogen and gastrin were increased in parasite-naive sheep by infection with either larval or adult H. contortus. Four sheep received 10000 larvae intraruminally and 9000 adult worms were given directly via an abomasal cannula to another 4 sheep. The latter animals were dosed orally with 0.4 mg kg-1 ivermectin 4 days after worm transfer and their recovery was monitored for a further 8 days. Whereas the presence of adult worms rapidly induced changes in the secretory activity of the abomasum, the early larval stages had minimal effects up to the 4th day post-infection. After either larval or adult infection, the initial hypergastrinaemia began at the same time as the increase in abomasal pH, but serum gastrin continued to increase after abomasal pH had reached a maximum and returned more slowly to normal values after drenching. The increase in serum pepsinogen did not precede those in the other parameters, unlike the earlier hyperpepsinogenaemia which occurs with Ostertagia infection. Three of the 8 infected sheep had no detectable serum pepsinogen increase during the parasitism while showing typical effects on abomasal pH and serum gastrin. The rapidity of the responses to the transfer of adult worms and to their removal by treatment with anthelmintic supports a role for worm excretory/secretory (ES) products which possibly are not produced by the early larval stages. The similarity of responses to H. contortus and O. circumcincta infection suggests the involvement of the same or very similar ES products.

Sex, gonads, sex hormones and histamine-stimulated gastric acid and serum pepsinogen

OBJECTIVE AND DESIGN

The effects of sex, sex hormones and gonads were studied in dogs because men secrete more acid than woman and duodenal ulcer is commoner in men and remits in pregnancy and after stilboestrol.

MATERIAL

Four male and 4 female greyhounds with chronic gastric fistulas were tested.

METHODS

Histamine was infused i.v. 1-16 micrograms/min and plateau acid output measured in the last 30 min of each 60 min infusion.

TREATMENT

The gonads were then removed and secretion retested. The orchidectomised dogs were then given stilboestrol 2 mg daily (+/-progesterone 25 mg i.m. three times a week) and the oophorectomised bitches given testosterone propionate 25 mg twice weekly i.m. and secretion again retested.

RESULTS

Submaximal and maximal acid outputs (and serum pepsinogen) of dogs and bitches were similar and correlated with body weight. Gonadectomy did not alter these functions nor did hormones of the opposite sex given for 1-12 months.

CONCLUSIONS

In the dog, as in the rat, and probably in man, histamine-stimulated gastric acid output is a function of body size and not of sex.

High prevalence of serum immunoglobulin G antibody to Helicobacter pylori and raised serum gastrin and pepsinogen levels in enlarged fold gastritis

To clarify the prevalence of Helicobacter pylori infection in enlarged fold gastritis, serum immunoglobulin (Ig) G antibody to H pylori was determined in 19 patients with severely enlarged gastric body folds (the widest fold greater than 10 mm on the radiograph), 55 patients with moderately enlarged folds (6 to 10 mm) and 44 control subjects (5 mm or less). The prevalence of serum IgG antibody to H pylori in the severe (100%) and moderate groups (100%) was significantly higher than that in controls (34.1%) (P < 0.01). There were significant differences among the three groups in serum gastrin, pepsinogen I and pepsinogen II levels (severe had the highest levels, followed by moderate and then controls, P < 0.001). H pylori colonization in the gastric mucosa was confirmed by culture, urease test or both, and inflammation by hematoxylin and eosin stain in the 25 H pylori seropositive patients who underwent endoscopy and biopsy. Results suggest that H pylori infection is highly prevalent in enlarged fold gastritis. Further studies on enlarged fold gastritis and H pylori infection are needed.

Enhanced cellular proliferation and p53 accumulation in gastric mucosa chronically infected with Helicobacter pylori

This study evaluated whether the increased risk of development of gastric carcinoma due to chronic Helicobacter pylori infection could be linked with elevated cell proliferative activity and expression of p53 and bcl-2. Forty-eight patients undergoing therapy for H pylori-positive gastroduodenal ulcers were separated into not eradicated (NE; n = 23) and eradicated (E; n = 25) groups 6 months after the treatment. Serum pepsinogen (PG) I:II ratios and histologic changes in the gastric corpus and the antrum, assessed according to the modified Sydney System, as well as epithelial cell proliferation (mitosis, Ki67, and proliferating cell nuclear antigen [PCNA]), and expression of oncoproteins (p53 and bcl-2) were examined before and at 3 months and 6 months after treatment for H pylori. Chronic persistent H pylori infection was associated with a low PG I:II ratio, increased inflammation and activity score, and elevated cell proliferation, as evidenced by the Ki67 and PCNA labeling indexes and the mitotic index in the NE group. Scattered accumulation of p53 protein continued to be observed in the NE group after treatment but was significantly decreased in the E group. We conclude that persistent H pylori infection causes gastritis, with epithelial degeneration and regeneration that result in accentuation of epithelial cell proliferation and accumulation of p53 protein, presumably heightening the genetic instability consistent with the development of carcinoma.

The usefulness of gastric mass screening using serum pepsinogen levels compared with photofluorography

Chronic atrophic gastritis, which is though to be a high risk for gastric cancer, can be diagnosed by serum pepsinogen levels. We compared the usefulness of the measurement of pepsinogen levels and indirect photofluorography as indicators of gastric cancer in a mass screening involving 5,620 Japanese subjects (mean age: 60.1 years old; male : female = 2,268:3,352) in 1991 and 1992. Subjects with a serum pepsinogen I level below 30 micrograms/liter or a pepsinogen I/II ratio below 2.0 were considered to be at high risk of gastric cancer. The incidence of gastric cancer and the ratio of early cancers detected by pepsinogen levels (0.12%, 4/7) were similar to those detected by photofluorography (0.11%, 4/6). Our results showed that mass screening using pepsinogen levels was as useful as indirect photofluorography for the detection of gastric cancer in Japan. In addition, our results showed that the sensitivity of gastric mass screening was increased when the measurement of serum pepsinogen levels was combined with photofluorography.

The influence of a Cooperia oncophora priming on a concurrent challenge with Ostertagia ostertagi and C. oncophora in calves

The development of immunity to Ostertagia ostertagi and Cooperia oncophora and interactions between these species were investigated in experimentally infected calves. Parasitological, serological and histological parameters were used for assessing immune responses. No conclusive evidence of an effect of C. oncophora on the course of an O. ostertagi infection in calves could be shown. Following a challenge with C. oncophora and O. ostertagi of C. oncophora primed calves, no significant reductions in establishment rate, faecal egg counts, worm length or the percentage of early fourth stage larvae could be demonstrated. Results also confirmed earlier work showing the very different degrees of immunity conferred following immunisation with either C. oncophora or O. ostertagi. While a protective immunity was generated in the case of C. oncophora, continuous infection of calves with 420000 L3 of O. ostertagi during almost 5 months induced immune reactions which affected growth and fecundity of the worms but not the establishment rate.

Pathophysiological aspects of Mecistocirrus digitatus (Nematoda: Trichostrongylidae) infection in calves

Three groups of four calves were experimentally infected with infectious larvae of Mecistocirrus digitatus. One group received a trickle infection of 5000 L3 per day for 8 days, the other two groups received a single infection of 5000 and 40,000 L3, respectively. All animals were necropsied 120 days after infection. Prepatent periods varied between 61 and 79 days, and maximal faecal egg output was reached between 80 and 100 days after infection. Repeated infections were not additive and worm counts at 120 days after infection varied between 100 and 440 in the first two groups and between 120 and 1700 in the last group. There was no significant difference in worm counts between the different infection regimes. However, there was a significant positive relationship between worm burden and faecal egg counts. In addition, there were significant negative relationships between worm burden and packed cell volume, and weight gain. The relative decreases in packed cell volume and weight gain emerged 70-80 days after infection. Serum pepsinogen levels were significantly elevated by the end of the trial, but the observed positive relationship between worm burden and pepsinogen was not significant. An enzyme immunoassay based on crude adult antigen was able to detect M. digitatus infection at 90 and 100 days after infection, but again there was no significant association between worm burden and antibody levels. Therefore, anaemia and a reduction in weight gain caused by the haematophagous activity of adult stages seem to be the most important pathogenic effects of M. digitatus infection in calves.

Genetic markers and duodenal ulcer

Serum pepsinogen, alpha 1-antitrypsin (alpha 1-AT) and blood groups were studied as genetic markers in 32 patients with endoscopically proven duodenal ulcer and 44 control subjects with no family history of ulcer disease. Serum pepsinogen was determined by the modified method of Edward et al, alpha 1-AT by single radial immunodiffusion (RID) and phenotyping was carried out by isoelectric focusing (IEF). Duodenal ulcer patients with hyper- pepsinogenemia (28%) and low serum alpha 1-AT (35%) had a dominant blood group O, lower mean age, an early onset of disease, a higher frequency of gastrointestinal (GI) bleeding and ulcer perforation. These parameters were found considerably different in patients with normal serum pepsinogen and alpha 1-AT. Phenotype analysis of alpha 1-AT revealed that four duodenal ulcer patients had partial deficiency of the protease inhibitor and none of the normal exhibited the deficiency pattern. The etiology of the disease appears to be genetic anomaly in 28% of patients while the rest (72%) had ulcers as a result of neuroendocrinological or environmental factors.

Field evaluation of a fenbendazole slow release bolus in the control of nematode infections in first-season cattle

The efficacy of a fenbendazole slow release bolus in controlling nematode infections of first-season cattle was evaluated in a field study in northern Germany. Two groups, each of 11 male calves, were set-stocked on separate pastures from May until October 1989 (157 days). The animals of one group were given the bolus at turnout and the animals of the control group were treated with fenbendazole (7.5 mg/kg bodyweight) eight weeks after turnout. Clinical inspections and measurements of faecal egg and larval counts, herbage trichostrongyle larval counts, plasma pepsinogen concentrations and bodyweight were made throughout the study. All the animals were slaughtered for worm counts and the evaluation of carcase quality two weeks after housing. The pasture grazed by the control group showed a marked increase in trichostrongyle larvae from late August onwards and, as a result, the control calves had increasing faecal egg counts and increased plasma pepsinogen concentrations in the latter part of the grazing season, although no clinical signs of parasitic gastroenteritis were apparent. The fenbendazole slow release bolus suppressed the trichostrongyle infections during the grazing season, and larval counts on the pasture grazed by the bolus-treated group remained low throughout the study. Postmortem examination showed that the bolus-treated calves harboured significantly (P < 0.01) fewer trichostrongyle worms, including inhibited stages, than the controls. Because of an inadequate lungworm challenge during the grazing season it was not possible to evaluate the efficacy of the fenbendazole slow release bolus in preventing parasitic bronchitis. At slaughter, the bolus-treated animals weighed more than the controls and tended to have a better carcase quality.

Gastrointestinal nematode infections of first-season grazing calves in Belgium: general patterns and the effect of chemoprophylaxis

Comparative analyses of the patterns of gastrointestinal nematode infections of first-grazing season cattle in Belgium are presented. The analysis involves 17 studies covering a 10 year period on 13 different farms in Flanders, Belgium. In all studies the calves were divided into an untreated control group, and one or two groups treated with chemoprophylactic systems. Two general infection levels emerged-'sub-clinical' (14 studies) and 'clinical' (three studies). The 'sub-clinical' infections were characterised by no clinical signs of parasitic gastroenteritis in the untreated control groups. Mean faecal egg counts remained low (less than 200), maximum pepsinogen levels only reached about 3500 mU tyrosine, and very small reductions in overall daily weight gain were observed compared with calves given chemoprophylaxis (less than 40 g day-1). Based on these results, on these 'sub-clinical' farms, chemoprophylaxis may not have been needed. In contrast, multiple salvage treatments of the control calf groups were required in the 'clinical' infections. Even with these salvage treatments mean faecal egg counts were high (more than 300), maximum pepsinogen levels were over 5500 mU tyrosine and there was a very large reduction in overall daily weight gain (more than 300 g day-1). However, it was not possible to predict either at turnout, or during the first month afterwards whether an infection on a particular farm would develop into a 'clinical' infestation. With the present data this prediction was possible from 8 weeks (Day 56) onwards, based on faecal egg counts and pasture larval contamination. It was also possible to predict using serum pepsinogen levels on Day 84. Therefore, one possible strategy for the effective control of gastrointestinal nematode infections of calves in temperate regions would be to evaluate faecal egg counts 2 months after turnout, and then only start treatment (i.e. metaphylaxis) if required.

Risk for gastric cancer in people with CagA positive or CagA negative Helicobacter pylori infection

BACKGROUND AND AIMS

It is not known why some people with Helicobacter pylori infection develop gastric cancer whereas others do not. Whether the CagA phenotype of H pylori infection affected risk for cancer independently of other posited risk factors was evaluated.

SUBJECTS

242 persons who participated in a previous nested case-control study of gastric cancer. 179 (90 cases and 89 controls) were infected with H pylori as determined by enzyme linked immunosorbent assay (ELISA) in serum and 63 (13 cases and 50 controls) were uninfected.

METHODS

Serum samples from cases and controls, obtained a mean of 14.2 years before diagnosis of cancer in the cases, were tested by ELISA for IgG antibodies against the CagA gene product of H pylori. They had previously been tested for pepsinogen I. Using logistic regression analysis, risk for cancer was compared among infected persons with CagA antibodies, infected persons without CagA antibodies, and uninfected persons.

RESULTS

Subjects infected with H pylori who had CagA antibodies were 5.8-fold more likely than uninfected subjects to develop gastric cancer (95% confidence interval (95% CI) = 2.6-13.0). This was true for both intestinal (odds ratio (OR) 5.1, 95% CI = 2.1-12.2) and diffuse type (OR 10.1, 95% CI = 2.2-47.4) cancers. By contrast, H pylori infected subjects without CagA antibodies were only slightly, and not significantly, at increased risk for cancer (OR 2.2, 95% CI = 0.9-5.4) and any possible association was restricted to diffuse type carcinoma (OR 9.0, 95% CI = 1.2-65.8). Pepsinogen 1 < 50 ng/ml significantly increased risk for both cancer types in H pylori infected persons and lessened the magnitude of association between CagA and cancer. Educational attainment, cigarette smoking, and ABO blood group were not associated with malignancy.

CONCLUSIONS

When compared with uninfected subjects, persons infected with CagA positive H pylori are at considerably increased risk of gastric cancer. CagA negative H pylori are less strongly linked to malignancy and may only be associated with diffuse type disease.

Influence of pepsinogen gene polymorphisms on serum pepsinogen

We identified pepsinogen C (PGC) gene polymorphisms by means of PCR, which amplified DNA in the region within the intron between exons 7 and 8, and by 6% polyacrylamide gel electrophoresis. Six alleles were found in a Japanese population. The frequencies of these alleles in 408 unrelated Japanese individuals were 0.074, 0.026, 0.335, 0.237, 0.016 and 0.314, respectively. The serum pepsinogen II level significantly decreased in the order of the allele 6 homozygote, the allele 6 heterozygote and the other genotypes (chi 2 = 7.850, D.F. = 2, p = 0.020). These findings indicated that the genetic background of serum pepsinogen should be considered when screening for stomach cancer by this procedure.

Helicobacter pylori infection and genetic polymorphisms for cancer-related genes in gastric carcinogenesis

The development of gastric cancer is a multistep process that is multi-factorial. An association with the Helicobacter pylori infections, gastric atrophy and gastric cancer has received recent attention. The objective of this study was to elucidate the risk factors for gastric cancer by using molecular epidemiological techniques for genetic susceptibility, gastric atrophy and serum markers including H pylori infection. We used an age- and gender-matched case-control study, where patients with benign gastric lesions were the controls. Low serum pepsinogen I levels (cut-off < 50 ng/mL) and low pepsinogen I/pepsinogen II ratios (cut-off < 3.0) were significantly associated with the risk of gastric cancer (odds ratio [OR] = 3.53: 95% confidence interval [CI] = 2.46-5.09 and OR = 4.73: 3.26-6.88, respectively). However, seropositivity of serum immunoglobulin G (IgG) antibody against H pylori (OR = 1.09: 0.74-1.61) was not associated with gastric cancer, even when analyzed by age greater than or less then 50 years. Specific genotypes of the cytochrome p450 2E1 (CYP2E1) RsaI polymorphism and glutathione-S-transferase (GST) M1 gene deletion were determined but were not associated with gastric cancer; however, a Lmyc genetic polymorphism was associated with gastric cancer (OR = 1.55: 1.03-2.34). Therefore, in this Japanese study, atrophic mucosal change, indicated by serum pepsinogen levels, is a possible risk factor for gastric cancer.

Percentage changes in serum pepsinogens are useful as indices of eradication of Helicobacter pylori

OBJECTIVE

Eradication of Helicobacter pylori has been gaining significance for the treatment of gastroduodenal diseases. Establishment of a precise diagnostic method for H. pylori is of great value. The aim of this study was to establish a new method for precisely judging the eradication of this bacteria.

METHODS

We measured serum pepsinogen I (PG I) and pepsinogen II (PG II) levels in 105 cases of peptic ulcer with H. pylori infection before and after anti-H. pylori treatment, determined percentage changes in serum PG I:PG II ratios before and 1 month after the treatment, and established cut-off values for them to distinguish success from failure of H. pylori eradication. Cut-off values for percentage changes in serum PG I:PG II ratios were tentatively set as +40%, +25%, and +10% when the serum PG I:PG II ratios before treatment were less than 3.0, not less than 3.0 but less than 5.0, and not less than 5.0, respectively.

RESULTS

With these cut-off values, the sensitivity, specificity, and validity for determination of eradication of H. pylori-on the basis of culture, histology, the rapid urease test, and a polymerase chain reaction method-were 100.0%, 93.1%, and 96.2%, respectively. These cut-off values could be applied to both gastric ulcer and duodenal ulcer.

CONCLUSION

Our findings suggest that percentage changes in serum PG I:PG II ratios are useful as indices for distinguishing success from failure in eradication therapy for H. pylori.

Cure of Helicobacter pylori infection in the elderly: effects of eradication on gastritis and serological markers

BACKGROUND

Specific data on anti-H. pylori treatments in elderly people are very scarce. The aim of the study was to evaluate in the elderly the efficacy of different anti-H. pylori therapies and the behaviour of serum anti-H. pylori antibodies, pepsinogen A and C, and PGA/PGC ratio induced by the anti-H. pylori treatment.

METHODS

One hundred and twenty-one dyspeptic patients aged > 60 years (mean age, 73 years; range, 61-89 years) with H. pylori-positive gastric ulcers (17 patients), duodenal ulcers (33 patients) or chronic gastritis (71 patients) were treated with one of the following anti-H. pylori treatments: (A) omeprazole 20 mg/day plus azithromycin 500 mg/day for 3 days; (B) omeprazole 20 mg/day plus azithromycin 500 mg/day for 3 days plus metronidazole 250 mg q.d.s. for 7 days; (C) omeprazole 40 mg/day plus azithromycin 500 mg/day for 3 days plus metronidazole 250 q.d.s. for 7 days; (D) omeprazole 20 mg/day plus clarithromycin 250 b.d. for 7 days; (E) omeprazole 20 mg/day plus clarithromycin 250 b.d. for 7 days plus metronidazole 250 q.d.s. for 7 days; and (F) omeprazole 40 mg/day plus clarithromycin 250 mg b.d. for 7 days plus metronidazole 250 mg q.d.s. for 7 days. At the baseline and 2 months after therapy, endoscopy and serum anti-H. pylori antibodies, pepsinogen A and C, and PGA/PGC ratio were measured.

RESULTS

Ten patients (8.2%) dropped out of the study. Six patients (4.9%) reported side-effects. The eradication rates of the six regimens, expressed using intention-to-treat and per protocol analysis, were, respectively: (A) 39% and 44%; (B) 50% and 56%; (C) 65% and 77%; (D) 47% and 50%; (E) 85% and 90%; and (F) 83% and 87%. The triple therapy for regimens E and F was significantly more effective than dual therapies (regimens A and D; intention-to-treat = P < 0.007, per protocol = P < 0.001) or the triple therapy for regimens B and C (intention-to-treat = P < 0.009, per protocol = P < 0.03). Patients cured of H. pylori infection showed a significant decrease in the activity of gastritis (P < 0.0001), a significant drop in IgG anti-H. pylori (P = 0.0004) and pepsinogen C (P < 0.0001), and an increase in PGA/PGC ratio (P < 0.001), while patients remaining H. pylori-positive showed no changes in the serum parameters.

CONCLUSIONS

In the elderly, triple therapy with omeprazole+metronidazole+clarithromycin for 1 week is well tolerated and highly effective; anti-H. pylori antibody and PGC serum levels decrease soon after anti-H. pylori therapy only in patients cured of H. pylori infection.

[Comparative study between seric I pepsinogen and seric gastrin, in the differentiation of the different types and localizations of chronic gastritis]

The present work analyzes the serie levels of pepsinogen I (PG I) and gastrin in relation to the histopathological findings with the optical microscope (OM) and electron microscope (EM) of different gastric mucosa biopsies obtained through fibrogastroscopy. 45 patients were studied (19 men and 26 women) with an average age of 63 with different clinical diagnoses documented later by fibrogastroscopy (peptic ulcer, neoplasia etc.), whose previous consent, two biopsies were taken at an antrum level and two biopsies at a fundic-body area level, analyzed later by OM and EM. The anatomopathological criteria followed in order to classify the condition of the mucosa was Whitehead's classification. The PG I and gastrin determination was carried out with RIA against a control group of 25 healthy individuals. Our study allows us to conclude that the normal or high serie concentration of PG I reflects a functional integrity of the fundic-body area, and low levels imply the presence of atrophic chronic gastritis at a fundic-body level. Thus a low level of PG I is a reliable marker of the atrophic condition of the mucosa and it can be considered as a precancerous factor.

Association between Helicobacter pylori infection and serum pepsinogen concentrations in gastroduodenal disease

AIM

To investigate the association between Helicobacter pylori infection and serum pepsinogen (PG) 1 and 2 concentrations in various gastroduodenal diseases.

METHODS

Serum PG1 and 2 concentrations and antibodies to H pylori were measured by enzyme linked immunosorbent assay (ELISA); gastric mucosal pH was assessed and urease activity in biopsy tissue was determined. A comparison of the ELISA and urease test results permitted division of the cases into positive, false positive, false negative and negative categories for control, gastritis, and ulcer groups.

RESULTS

The gastric mucosal pH and serum PG2 in cases positive for H pylori were significantly increased in ulcer and gastritis cases compared with H pylori negative cases. Similar tendencies were observed for the false positive and false negative categories.

CONCLUSIONS

A positive ELISA reaction for antibodies and an increased serum PG2 concentration are reliable indicators of H pylori infection.

[An investigation of the factors influencing serum pepsinogen levels--sex, age, smoking, drinking]

BACKGROUND

Until now, the influence of sex, age, smoking, drinking on serum pepsinogen levels has been assessed by single regression analysis. However, the influence of those factors on pepsinogen levels should be assessed exactly by multiple regression analyses.

SUBJECTS AND METHODS

891 subjects were collected from by questionnaire and serum tests. Analyses were done with serum pepsinogen I (PG I), pepsinogen II (PG II) and pepsinogen I/II ratio (PG I/II) as a criterion variable and as categorized explanatory variables, sex, age, current or past smoking habit, and current drinking habit. And analyses are done by Mann-Whitney U test, correlation coefficient, single regression method, multiple regression method.

RESULTS

PG I level is significantly higher in men than in women by Mann-Whitney U test. But the effect of sex factor is not remarkable by multiple regression analyses. PG II level increased and PG I/II level decreased with progression of age by all analyses methods. Current or past smoking elevates PG I level by Mann-Whitney U test, but current smoking dose and past smoking amount showed no dose-dependent associations with PG I level. Current drinking elevates PG I level by Mann-Whitney U test, but current drinking dose showed no dose-dependent associations with PG I. However, the effects of current smoking and current drinking to serum PG levels is not so large by multiple regression analyses.

CONCLUSION

The effects of sex, current smoking and current drinking to serum PG levels are not remarkable by multiple regression analyses. Significantly, PG II level increased and PG I/II level decreased with progression of age. Therefore it may not be necessary to consider the effects of sex, smoking habit and drinking habit when serum pepsinogen levels are used as markers for gastric cancer.