Risk of gastric carcinoma in patients with mucosal dysplasia associated with atrophic gastritis: a follow up study

AIMS

To assess the risk of gastric carcinoma in patients with histologically verified dysplasia and atrophic gastritis of the stomach.

METHODS

One hundred and one patients with mild (n = 84), moderate (n = 14), or severe (n = 3) dysplasia among 359 elderly men who smoked underwent gastroscopy because of low serum pepsinogen. Patients with dysplasia were prospectively followed up for an average of four years with repeated gastroscopies and multiple biopsies.

RESULTS

Four of the 84 (4.8%) cases of mild dysplasia had progressed to moderate dysplasia during the follow up. Most of the cases of mild dysplasia had resolved spontaneously. No surgical intervention was required. Three of the 14 (21%) cases of moderate dysplasia had progressed to severe dysplasia, but no carcinomas were observed during follow up. Five moderately dysplastic lesions were removed surgically or endoscopically. In two of these five cases, moderate or severe dysplasia recurred. Two of the three severe dysplasias progressed to carcinoma.

CONCLUSIONS

In atrophic gastritis progression of mild and moderate dysplastic lesions seems to be a slow process and is rare in mild dysplasia. However, severe dysplasia is highly predictive of subsequent cancer. It is suggested that a five year follow up interval is sufficient in cases with mild dysplasia and two years in those with moderate dysplasia. Local removal of moderate dysplasia is indicated but does not guarantee that the lesion will not progress. Severe dysplasia requires immediate surgical intervention.

Pepsinogens and gastrointestinal symptoms in mountain marathon runners

Although there are various descriptive reports concerning exercise-induced gastrointestinal distress, the role of gastrointestinal hormones and/or enzymes is not definitively established. In this study we investigated the behaviour of pepsinogens (PGI and PGII) after an endurance race performed at an altitude of 4,300 m by 13 well-trained marathon runners, with the aim to establish their interrelationship with gastrointestinal distress and with the modifications of gastrin and cortisol. The athletes showed a significant rise in gastrin (p < 0.01) and in cortisol (p < 0.01) and a significant decrease in PGI (p < 0.01) and PGII (p < 0.05) after the race. The PGI/PGII ratio presented small variations indicating that heavy exercise has less effects on PGs than those observed for gastrin. Gastrointestinal symptoms occurred in 6 athletes (46%) during the race and in 8 athletes (62%) after the race. No relationship was found between gastrointestinal symptoms and hormonal modifications after the race. A control group of 5 subjects was used: they (n = 5) did not show any significant modification of gastrin and PGs during the period spent at the above altitude, indicating that travel, altitude and acclimatization, food and beverages, do not influence the behaviour of these hormones. Conversely, they presented a significant decrease of cortisol (p < 0.05) linked to the circadian rhythm. The data of the present study indicate that the potential damage of gastrointestinal apparatus in mountain marathon runners is not related to the above mentioned hormones.

Site of peptic ulcer. comparison of hydrochloric acid output, pepsinogen and gastrin serum levels

BACKGROUND/AIMS

Basal (BAO) and maximum (PAO) hydrochloric acid output after Histalog stimulation, basal pepsinogen (SPL-B), at 60 (SPL-60) and at 90 minutes (SPL-90), and basal gastrin (BG) levels were measured and compared in different gastric (GU) and duodenal (DU) ulcer sites.

MATERIAL AND METHODS

Fifty nine patients with peptic ulcer were grouped according to Johnson's classification for gastric ulcers: type I (15), type II (16) type III (12) GU and (16) DU. Fifteen normal subjects were studied as controls.

RESULTS

The BAO was greater in the DU than in the control or GU groups. No significant difference was noted in the production of hydrochloric acid after stimulation with Histalog. The SPL-B, at 60 and at 90 minutes was higher in type II GU than in the DU group and controls. The SPL-60 was higher in type II GU patients than in type III GU. Basal gastrin was higher in group DU and types II and III GU compared to the type I GU patients and controls.

CONCLUSION

The topographic criteria for differentiating peptic ulcers has low discrimination capacity based on comparison of mean values of HCl acid production, pepsinogen and gastrin serum levels both basal and after stimulation with Histalog due to heterogeneity of these variables in group studies. In these studies, peptic ulcers from different sites should not be grouped as distinct entities except for type II gastric ulcers.

Serum pepsinogen I levels and acid secretion in Helicobacter pylori associated enlarged fold gastritis

It has been shown that serum pepsinogen I levels are correlated with maximal acid outputs and can be used as an indicator for parietal cell mass. In this study, the effect of Helicobacter pylori infection on the relationship between serum pepsinogen I levels and maximal acid outputs was investigated in 27 patients with Helicobacter pylori associated enlarged fold gastritis. Before treatment, serum pepsinogen I levels and maximal acid outputs were not significantly correlated. After eradication of Helicobacter pylori, a significant positive correlation was found between serum pepsinogen I levels and maximal acid outputs with a significant increase in pepsinogen I levels and a significant increase in maximal acid outputs. These results indicate that Helicobacter pylori infection distorts the relationship between serum pepsinogen I levels and maximal acid outputs by elevating the former and lowering the latter, and that serum pepsinogen I level after eradication of Helicobacter pylori may reflect parietal cell mass in patients with Helicobacter pylori associated enlarged fold gastritis.

Infection of sheep with adult and larval Ostertagia circumcincta: effects on abomasal pH and serum gastrin and pepsinogen

Infection of sheep with adult or larval O. circumcincta increased serum pepsinogen and gastrin and abomasal pH. The upper limits of the normal range, calculated from over 1000 samples collected from parasite-naive sheep, were set at 2 standard deviations above the mean; these were for serum pepsinogen, 454 mU tyrosine l-1; serum gastrin, 64 pM and abomasal pH, 3.26. Five infection regimes were used: sheep previously exposed to field parasitism were infected with 30,000 larvae intraruminally (Group A), while parasite-naive sheep were administered either 50,000 larvae intraruminally (Group B), 150,000 larvae intraruminally followed by a trickle infection of 10,000 larvae thrice weekly from days 21 to 45 (Group C), 150,000 exsheathed larvae via an abomasal cannula (Group D) or 15,000 adult worms via an abomasal cannula (Group E). Whereas the presence of adult worms rapidly increased serum pepsinogen (after 8 h) and abomasal pH and serum gastrin (after about 19 h), the early infective larval stages, regardless of the infection regime, had minimal effects until the abrupt rise in all parameters 5-6 days after infection. Abomasal pH returned to near normal levels when the infections became patent and was not re-elevated by a subsequent trickle infection, whereas serum gastrin and pepsinogen remained high. The initial hypergastrinaemia was coincident with the increased abomasal pH, but was preceded by the increase in serum pepsinogen. In several sheep, serum pepsinogen increased very little during the parasitism, although there were typical effects on abomasal pH and serum gastrin. Serum gastrin was depressed when the abomasal pH exceeded about 5.5. It is suggested that an inhibitor of gastrin release is generated by proliferating abomasal microbes under these conditions and that this is a limitation to the use of elevated serum gastrin in the diagnosis of parasitism in individual sheep.

The development of protective immunity against gastrointestinal nematode and lungworm infections after use of an ivermectin bolus in first-year grazing calves

Interactions between treatment with an ivermectin bolus at turnout and immunity to bovine parasitic gastroenteritis and bronchitis were examined. Immunity related parameters, i.e. development of clinical disease, parasite development and stimulation of parasite specific antibodies were examined for two grazing seasons and compared with untreated second season cattle (immune control) and untreated parasite naive cattle (nonimmune control). With respect to gastrointestinal nematodes, clinical condition, body weight development, faecal egg counts and pepsinogen concentrations of the bolus treated animals were not significantly different from the respective values of untreated immune cattle, showing a considerable degree of resistance in both groups compared to the parasite naive cattle. With respect to lungworms, untreated immune cattle were protected against clinical disease, but two of eight animals shed larvae again. Bolus treated animals transiently showed mild clinical symptoms and six of seven animals shed low numbers of larvae again, whereas all parasite naive cattle shed high numbers of lungworm larvae and showed signs of disease during the whole grazing season. In spite of the effective treatment with an ivermectin bolus during the first year a considerable resistance to gastrointestinal nematode and lungworm infection was present in the second grazing season.

Risk factors of peptic ulcer disease: different impact of Helicobacter pylori in Dutch and Japanese populations?

Helicobacter pylori, non-steroidal anti-inflammatory drugs, family history, blood group O, hyperpepsinogenaemia A, alcohol and smoking have been reported to be risk factors for peptic ulcer disease. The strength of causal risk factors may differ in different populations. In 215 Japanese and 493 Dutch employees of similar age, gender and type of occupation, a structured history was obtained using a questionnaire and fasting serum samples were analysed for IgG antibodies to H. pylori and pepsinogen A all in the same laboratory. A past ulcer history was verified through case notes. We found that H. pylori seropositivity, a high serum pepsinogen A and a family history of ulcer disease were significant and independent risk factors for peptic ulcer disease. For H. pylori seropositivity there was a 20-fold increased risk among the Dutch and an eight-fold increased risk among the Japanese. The seroprevalence of H. pylori was 90% in 20 Dutch subjects with a verified ulcer history and 95% in 41 Japanese ulcer subjects; it was 29% in Dutch non-ulcer subjects and 70% in Japanese non-ulcer subjects. The cumulative difference in risk to develop peptic ulcer disease at the age of 48 years between H. pylori-infected and -uninfected subjects was 24.5-3.0 = 21.5% for the Japanese and 11.8-0.5 = 11.3% for the Dutch. Duodenal ulcer disease was associated with a high coffee consumption only among the Japanese population, where this habit was much less prevalent than among the Dutch. In conclusion, the characterization of peptic ulcer risk factors as weak or strong has no universal basis: the present study shows that from a diagnostic point of view H. pylori appears to be a weaker risk factor for peptic ulcer disease in a society with a higher seroprevalence. However, from an aetiological point of view, H. pylori has an even greater impact on ulcer morbidity in the Japanese than in the Dutch population.

Antral gastrin cell hyperfunction and Helicobacter pylori infection

BACKGROUND

Antral gastrin cell hyperfunction (AGCH), is a rare cause of duodenal ulcer associated with non-tumour hypergastrinaemia and acid hypersecretion.

AIM

To investigate the role of Helicobacter pylori in AGCH.

PATIENTS

Twelve AGCH patients and eight H. pyloripositive non-hypergastrinaemic duodenal ulcer patients were compared.

METHODS

Basal and peak acid outputs, gastrin-stimulation (meal and bombesin) tests, and immunohistochemistry for antral G and D cells were performed. One year after H. pylori eradication, six AGCH patients were again investigated with the same tests.

RESULTS

Significantly more basal, and stimulated gastrin and acid secretion, were found in AGCH compared to the H. pylori-positive duodenal ulcer patients (P < 0.01). G cell counts were significantly higher in AGCH than in duodenal ulcer patients (118.8, range 58-192.4, vs. 86.1, range 49-184; P < 0.05), and the resulting G/D cell ratio was also higher in AGCH patients (4.2, range 2.6-5.6, vs. 3.3, range 1.9-4.3; P < 0.05). H. pylori was present in the gastric mucosa of all 12 AGCH patients. Cure of infection in six AGCH individuals resulted in marked a decrease of gastrin levels associated with a significant (23.7%: P < 0.05) decrease of G cell count and an increase (12%; P < 0.05) of D cell count.

CONCLUSIONS

The results indicate that AGCH may result from H. pylori overstimulation of gastrin cell function in patients with some presently undefined, familial predisposition and that an imbalance of the G/D cell ratio may have a role in the genesis of hypergastrinaemia.

Helicobacter pylori antibodies in relation to precancerous gastric lesions in a high-risk Chinese population

Helicobacter pylori infection is a major cause of gastritis and may be a key risk factor for stomach cancer, but its role in the process of gastric carcinogenesis is not well understood. Herein, we examine H. pylori prevalence in relation to demographic and lifestyle factors and to severity of precancerous lesions in an area of China with one of the highest rates of stomach cancer in the world. H. pylori serum IgG antibody positivity was assayed among 2646 adults, ages 35-64, participating in a population-based gastroscopic screening survey in the high-risk area. The prevalence of positivity was evaluated according to gastric histology, environmental and lifestyle variables determined by interviews during the screening, and level of serum pepsinogens. The odds of advanced precancerous lesions (intestinal metaplasia and dysplasia) of the stomach among those with antibody positivity were estimated by logistic regression. Seventy-two % of the population was H. pylori antibody-positive, with nonsignificant variation by sex, age, income, education, family size, and cigarette smoking habits. H. pylori positivity was higher among those who ate sour pancakes, a fermented indigenous staple that is a risk factor for gastric dysplasia and stomach cancer in this population. The prevalence of H. pylori varied most notably, however, with gastric pathology. The percent of H. pylori positivity increased from 55 to 60 to 87% among those with superficial (nonatrophic) gastritis, mild chronic atrophic gastritis, and severe chronic atrophic gastritis, respectively, before falling to 78% among those with intestinal metaplasia or dysplasia. H. pylori antibody positivity also was strongly correlated with serum pepsinogen concentrations, particularly pepsinogen II, but knowledge of H. pylori status did not markedly improve serological identification of advanced precancerous lesions above that provided by pepsinogen ratios alone. The findings suggest that H. pylori infection contributes to the process of gastric carcinogenesis, particularly during the early stages, in this high-risk area.

Circulating anti-Helicobacter pylori immunoglobulin A antibodies and low serum pepsinogen I level are associated with increased risk of gastric cancer

Helicobacter pylori infection has been suggested to be associated with an increased risk of gastric cancer, and low levels of serum pepsinogen I (PG I) have been linked to atrophic gastritis, which is a risk factor for gastric cancer. In Finland, 39,268 persons from 25 cohorts participated during 1968-1972 in a health examination survey and were followed for up to 13 years. A nested case-control study was performed on 84 stomach cancer patients identified from the Finnish Cancer Registry and 146 controls matched for age, sex, and municipality. Serum samples drawn at the baseline study were analyzed. An elevated level of serum anti-H. pylori immunoglobulin A (IgA) antibodies (a titer > or = 70) and a low serum PG I level ( < 49 micrograms/liter) were associated with an increased risk of gastric cancer. The odds ratios were 2.52 (95% confidence interval (CI) 1.14-5.57) for high IgA and 2.68 (95% CI 1.35-5.30) for low PG I. For high immunoglobulin G (IgG) ( > or = 700), the odds ratio was only 1.50 (95% CI 0.70-3.22). When both high IgA and low PG I were present, the odds ratio was 5.96 (95% CI 2.02-17.57). The association of H. pylori infection with cancer became stronger with longer follow-up times, whereas that of low PG I was strongest at shorter follow-up times. Our findings support the hypothesis that H. pylori infection is a prevalent and potentially preventable cause of gastric cancer. They stress the value of IgA antibody determinations and provide new evidence for a pathogenesis leading from prolonged infection through atrophic gastritis to gastric cancer.

Gastric emptying and first-pass metabolism of ethanol in elderly subjects with and without atrophic gastritis

BACKGROUND

Oral ethanol intake results in lower blood ethanol concentrations than intravenous administration of the same dose of ethanol. This first-pass metabolism is thought to be due to gastric metabolism of ethanol via alcohol dehydrogenase and also to hepatic first-pass metabolism.

METHODS

Since a loss of gastric mucosa may decrease first-pass metabolism of ethanol, this metabolism was studied in 10 elderly subjects (6 women and 4 men) with atrophic gastritis and bacterial overgrowth and in 17 control subjects with normal gastric secretory function. Atrophic gastritis was verified by means of the serum pepsinogen I to pepsinogen II ratio and the hypochlorhydria occurring after pentagastrin stimulation. Bacterial overgrowth was assessed by bacteria. In addition, gastric emptying rates of ethanol solution with technetium-99m sulfur colloid were calculated from scintigraphic images. Furthermore, gastric biopsy specimens were taken from 12 female patients with atrophic gastritis and from 12 controls for determination of alcohol dehydrogenase activity.

RESULTS

Neither gender (female versus male, 28 +/- 5% versus 42 +/- 5%), atrophic gastritis (normal versus atrophic gastritis, 35 +/- 4% versus 32 +/- 6%), nor tetracycline treatment in atrophic gastritis subjects (before versus after, 32 +/- 6% versus 41 +/- 5%) had a statistically significant effect on the first-pass metabolism of ethanol in the elderly. Gastric alcohol dehydrogenase activity was significantly lower in atrophic gastritis subjects than in controls (p < 0.01). A significant correlation was found between the first-pass metabolism of ethanol in healthy controls and gastric half-emptying time (p = 0.032).

CONCLUSIONS

We conclude from these data that the rate of gastric emptying modulates first-pass metabolism of ethanol in elderly individuals.

[A sero-epidemiological study on atrophic gastritis and Helicobacter pylori infection]

The aim of this study is to clarify the relationship between the incidence of atrophic gastritis and Helicobacter pylori infection. A case control study was conducted in 1995. Cases and controls were selected among those who took an annual health examination in a rural area of Fukuoka Prefecture. Cases are those who were not diagnosed as having atrophic gastritis in 1991 or 1992 but were diagnosed as having atrophic gastritis in 1995 by the examination of serum pepsinogens. Controls are those who were not diagnosed as having atrophic gastritis between 1991, or 1992 and 1995. Helicobacter pylori infection was evaluated by anti Helicobacter pylori IgG in 1995. The odds ratio for atrophic gastritis was calculated using Logistic regression analysis. The odds ratio of age and sex was not significant, but the odds ratio of Helicobacter pylori infection was significantly elevated (5.2, 95% confidence interval: 2.08-13.17). As for the influence of sex difference on the incidence of atrophic gastritis by Helicobacter pylori infection, the odds ratio among males was not significant (1.4, 95% confidence interval: 0.30-6.10), but the odds ratio among females was significantly high (9.8, 95% confidence interval: 2.82-34.11). These results suggest that Helicobacter pylori infection is associated with the incidence of atrophic gastritis. There may be a risk difference between males and females in the incidence of atrophic gastritis caused by Helicobacter pylori infection.

The clinical usefulness of serum pepsinogens, specific IgG anti-HP antibodies and gastrin for monitoring Helicobacter pylori treatment in older people

OBJECTIVE

To evaluate the clinical usefulness of Pepsinogen A (PGA) and C (PGC), PGA/PGC ratio, gastrin, and specific IgG anti-HP antibodies (anti-HP Ab) in monitoring the effect of cure for Helicobacter pylori (HP) infection in older people.

DESIGN

We studied the changes in serum parameters (PGA, PGC, PGA/PGC ratio, gastrin and anti-HP Ab) in older patients before and 2 months after stopping therapy for the cure of HP infection.

PATIENTS

Eighty-eight older patients (M = 43, F = 45, mean age = 73.3, range = 60-89) with chronic gastritis (42), gastric ulcer (14) or duodenal ulcer (32) were found HP-positive by histology of gastric antral and body biopsies and the rapid urease test.

INTERVENTIONS

Two different associations of antibiotics and antiulcer drugs (omeprazole, metronidazole, azithromycin, or clarithromycin) for 2-4 weeks.

MEASUREMENTS

At the beginning of the study and 2 months after treatment withdrawal, the subjects were studied by upper G.I. endoscopy with at least two antral and two body gastric biopsies (Giemsa stain and rapid urease test for HP); serum PGA (RIA method, microgram/mL), PGC (RIA method, microgram/mL), PGA/PGC ratio, gastrin (RIA method, picogr/mL), and anti-HP Ab (ELISA method, Biolife, MU/mL) were also determined. Statistical analysis was based on either the Wilcoxon test, for paired data, the chi-square test, the Kruskal Wallis test, or the Mann-Whitney test for unpaired data. The choice of the best cut-off value in the different parameters was performed by receiver operating characteristics curves (ROC) and by Youden index. The correlation between HP density in the gastric mucosa and gastritis activity was verified by Spearman rank correlation test.

RESULTS

After therapy, 56/88 patients proved HP-negative (HP-eradicated: M = 30, F = 26, mean age = 73.0, range = 60-87 years), whereas 32/88 were not cured (HP-persistent: M = 13, F = 19, mean age = 73.0, range = 60-89 years). After therapy, in HP-eradicated cases, a statistically significant change was found in anti-HP Ab (75.23 +/- 8.94 vs 47.32 +/- 5.26, P < .001), PGC (21.58 +/- 1.97 vs 14.34 +/- 1.75, P < .001), and PGA/PGC ratio (8.46 +/- 0.68 vs 11.54 +/- 0.89, P < .001), but not in PGA and gastrin. On the other hand, in HP-persistent cases, anti-HP Ab, PGA, PGC, PGA/ PGC ratio and gastrin did not change after therapy. The sensitivity and specificity were, respectively, 0.62 and 0.56 for anti-HP Ab and 0.75 and 0.56 for the PGA/PGC ratio, which demonstrated the best diagnostic accuracy (68%).

CONCLUSIONS

The eradication of HP from the stomach of older patients induces a rapid and significant decrease in serum levels of IgG anti-HP antibodies and PGC, with an increase in PGA/PGC ratio but not in gastrin. Unchanged serum levels of IgG anti-HP antibodies, PGC, and PGA/PGC ratio 2 months after completing HP eradication therapy are indicative of ongoing HP infection. The PGA/PGC ratio showed the best diagnostic accuracy among serum measures tested.

Helicobacter pylori infection in asymptomatic elderly subjects living at home or in a nursing home: effects on gastric function and nutritional status

Age and close living conditions are known to be risk factors for the acquisition of Helicobacter pylori (HP) infection. It is unknown whether institutionalization of asymptomatic, elderly subjects is an additional risk factor and whether gastric function and nutritional status are affected by the HP infection. The study sample comprised 102 subjects over 65 years of age: 52 living in a nursing home and 50 at home. No subject had symptoms or previous pathology related to the upper digestive tract. In all subjects, serum levels of specific anti-HP antibodies were determined. Gastric function was evaluated by levels of pepsinogen A (PGA), pepsinogen C (PGC) and gastrin. The nutritional status of the subject was evaluated by measuring: albumin, haemoglobin, iron, ferritin, transferrin, vitamin B12, and folic acid in blood, and body mass index and mid-arm muscle area. The prevalence of anti-HP antibodies was 86.5% in institutionalized subjects (men: 100%; women:76.6%, p <0.05) and 82.0% in subjects living at home (men:86.3%; women:76.3%). No differences between the two groups were observed in levels of serum anti-HP antibodies and PGC was identified. In neither group were differences observed between serum positive (HP + ve) and negative (HP - ve) subjects with respect to the biohumoral and anthropometric indices of nutritional status. We conclude: (1) the seroprevalence of the HP infection was high (82-86%) in asymptomatic elderly patients living either at home or in an institution; (2) the presence of specific IgG anti-HP antibodies in asymptomatic elderly individuals, at home or in a nursing home, was not associated with changes in PGA levels in institutionalized subjects; (3) nutritional indices were not influenced by the presence of anti-HP antibodies.

Helicobacter pylori serology in patients with chronic gastritis

OBJECTIVES

Helicobacter pylori (Hp) infection is known to cause several gastroduodenal diseases. In patients with non-ulcer dyspepsia, we assessed the link between Hp infection and gastric mucosal inflammation, as well as the influence of Hp and inflammation on the serum levels of anti-Hp antibodies (IgG), pepsinogen A (PGA), pepsinogen C (PGC), and gastrin.

METHODS

Entering the study were 221 patients with non-ulcer dyspepsia, all of whom underwent upper gastrointestinal endoscopy.

RESULTS

Of the 221 patients investigated, 135 (61%) were Hp positive. The higher the bacterial load, the worse the associated gastritis, the gastric antrum and body being considered. All of the serological indices studied were found to be influenced by gastritis. Serum IgG satisfactorily discriminated between Hp-positive and Hp-negative subjects, with a sensitivity of 84% and a specificity of 86%. PGC, PGA, and gastrin were less accurate. Only PGC only found to be correlated with Hp load. The product of IgG and PGC improved the diagnostic accuracy of IgG alone.

CONCLUSIONS

Hp infection, frequently found in patients with non-ulcer dyspepsia, is associated with gastric mucosal inflammation; of the indices studied, serum IgG and PGC most accurately indicated Hp infection, and their product may be proposed as an aid in diagnosing Hp infection in dyspeptic patients.

Helicobacter pylori infection is the major risk factor for atrophic gastritis

OBJECTIVE

To evaluate the association of both Helicobacter pylori (Hp) infection and advancing age with increased prevalence of atrophic gastritis.

METHODS

Two hundred and thirty-eight subjects who had no esophagitis, peptic ulcers, or malignancies in the upper gastrointestinal tract were divided into three groups according to age: group A, < 30 yr; group B, 30-49 yr; group C, > or = 50 yr. Two biopsy specimens were obtained from the lesser curvature of the antrum and two from the anterior and posterior walls of the fundus to assess the degree of gastritis and histological evidence of Hp infection. Hp infection was evaluated by Giemsa staining and serum IgG antibodies. Serum gastrin (SG) and pepsinogen (PG) were determined by radioimmunoassay.

RESULTS

In all age groups, the prevalence of atrophic gastritis was significantly more common in subjects with evidence of Hp infection. In Hp-positive subjects, the prevalence of atrophic gastritis increased with advancing age. Atrophic gastritis was extremely rare, regardless of age, in Hp-uninfected patients. SG increased, and PG I and the PG I:II ratio decreased with age in Hp-positive subjects. This trend was not apparent in Hp-negative subjects.

CONCLUSION

Our results suggest that Hp infection is a stronger predictor than advancing age for atrophic gastritis.

Genetic polymorphisms of the cancer related gene and Helicobacter pylori infection in Japanese gastric cancer patients. An age and gender matched case-control study

BACKGROUND

Gastric cancer is a multistage process, each caused by numerous factors. The objective of this study was to elucidate the risk factors for gastric cancer by using molecular epidemiologic techniques and serum markers.

METHODS

Serum pepsinogen I levels, pepsinogen I/pepsinogen II (I/II) ratios, serum IgG antibody against Helicobacter pylori (H. pylori), and genetic polymorphisms of cytochrome p450 2E1 (CYP2E1), glutathione-S-transferase M1 (GSTM1), and L-myc protooncogenes were analyzed in 82 persons with gastric cancer and in 151 age- and sex-matched controls, who were selected from 208 gastric cancer patients and 375 noncancer patients, respectively. Statistical analysis was performed to elucidate which risk factors for gastric cancer were contributing the most to gastric carcinogenicity.

RESULTS

Serum pepsinogen I level (odds ratio [OR] = 1.81; 95% confidence interval [CI], 1.04-3.16) and pepsinogen I/II ratios (OR = 3.09; 95% CI, 1.74-5.49) were significantly associated with gastric cancer risk in a case-control study. Seropositivity of serum IgG antibody against H. pylori (OR = 1.25; 95% CI, 0.84-1.85) and specific genotypes of a L-myc genetic polymorphism (OR = 1.33; 95% CI, 0.59-2.99) were more commonly observed in gastric cancer cases, but this was not statistically significant. Specific genotypes of the CYP2E1 RsaI polymorphism and GSTM1 gene deletion were not associated with gastric cancer.

CONCLUSIONS

Atrophic mucosal change, indicated by serum pepsinogen levels, is possible a risk factor for gastric cancer. H. pylori infection and genetic polymorphisms of CYP2E1, L-myc, and GSTM1 genetic polymorphisms were not risk factors in this study.

Helicobacter pylori gastritis and serum pepsinogen levels in a healthy population: development of a biomarker strategy for gastric atrophy in high risk groups

This study aimed to estimate the prevalence and type of chronic gastritis in an asymptomatic working population and to determine whether a combination of serum pepsinogen levels and Helicobacter pylori serology could be used to identify a subgroup with atrophic gastritis at elevated risk of gastric carcinoma. A 10% subsample of 544 male volunteer factory workers aged 18-63 years and participating in a larger study underwent endoscopy and biopsy. Of these men, 29 were seropositive for Helicobacter pylori; all but three (89.7%) had chronic gastritis. Serum pepsinogen A levels increased with progression from a corpus predominant pattern of gastritis through pangastritis to an antral predominant pattern. Nine subjects had corpus atrophy, which was in most cases accompanied by fasting hypochlorhydria and hypergastrinaemia. A combination of pepsinogen A below 80 ng ml-1 and Helicobaceter pylori seropositivity detected corpus atrophy with sensitivity 88.9% and specificity 92.3%. A second screening stage, using a pepsinogen A/C ratio of below 2.5 as a cut-off, resulted in a reduction in numbers requiring further investigation but with some loss of sensitivity (77.8%). Application of this two-stage screening programme to the original sample of 544 workers would have resulted in 11 (2.2%) men being selected for follow-up, excluding 25 (5.1%) false negatives. Our results suggest that a combination of serum pepsinogen levels and Helicobacter pylori serology could be useful as a biomarker strategy for detection of individuals at increased risk of gastric carcinoma and for non-invasive investigation of the natural history of Helicobacter pylori gastritis.

Atrophic changes of gastric mucosa are caused by Helicobacter pylori infection rather than aging: studies in asymptomatic Japanese adults

BACKGROUND

The current study was designed to evaluate the effect of aging and Helicobacter pylori infection on the gastric mucosa in asymptomatic Japanese adults.

MATERIALS AND METHODS

Eighty-five asymptomatic healthy adults were recruited from a health-screening center in Sapporo. All subjects underwent endoscopy and gastric biopsy, and serum was obtained for IgG antibodies to H. pylori, serum gastrin, and pepsinogen levels.

RESULTS

The prevalence of atrophic change of the gastric mucosa assessed by pathological findings increased with age (49% in the 30- to 39-year-old group compared to 89% in those 60 years and older, p < .001). The frequency of intestinal metaplasia also increased with age (38% in the 30- to 39-year-old group compared to 82% in those 60 years and older, p < .001). In contrast, the frequency of atrophic gastritis and intestinal metaplasia was extremely low in the H. pylori seronegative group regardless of age. Mean serum gastrin level in H. pylori-positive adults was significantly greater than in those who were H. pylori-negative (114.3 +/- 11.2 compared to 65.8 +/- 6.5 pg/ml, p < .03). The serum pepsinogen I-II ratio was significantly lower in those with H. pylori infection than in those without (3.1 compared to 6.6, p < .0001).

CONCLUSIONS

These results suggest that the chronological changes in the gastric mucosa in Japanese individuals are either entirely related to H. pylori infection or the process is greatly accelerated by H. pylori infection.

Response of cattle treated with a fenbendazole slow release bolus to challenge from nematodes the following season

Nematode infection of cattle treated in their first year at pasture with the fenbendazole slow release bolus ('Bolus group') was compared during the second year with that of untreated cattle. Ostertagia was the most prevalent parasite associated with Cooperia. Except for the Dictyocaulus spp. which caused clinical signs of bronchitis in the 'Bolus' group, the infection during the second year resulted in a moderate response of the cattle whatever the group. Rises in both pepsinogen and gastrin levels were correlated with the number of Ostertagia L3 on herbage. Damages in the abomasal mucosa were more frequent and severe in the 'Bolus' group where more inflammatory signs were observed in spite of a smaller number of worms. Nevertheless, the differences in total weight gains were not significant thanks to a compensatory effect during the second part of the grazing season in the 'Bolus' group. Hypotheses related to a minimum threshold of infection during the first year necessary to develop high enough protection during the second year are discussed. The pathological effects of gastrointestinal nematodes seem to vary more according to the inflammatory response than to the number of worms.

Verification of decreased basal and stimulated serum pepsinogen-I levels is a useful non-invasive method for determining the success of eradication therapy for Helicobacter pylori

BACKGROUND

We wanted to demonstrate the effect of Helicobacter pylori eradication on basal and stimulated pepsinogen-I levels in duodenal ulcer patients and to verify whether modification of such levels is a useful method for determining the success of eradication therapy.

METHODS

Thirty-two patients (24 men; mean age, 45 years) with active duodenal ulcer were studied. In all patients three biopsy specimens were taken from the duodenal bulb, gastric antrum, body and fundus for microbiologic and histologic examination. Triple therapy consisting of bismuth, metronidazole, and tetracycline was administered. Endoscopy was repeated 1 month after completing therapy, and biopsy specimens were again taken from the gastric antrum and body. Serum samples were taken at initial and repeat endoscopies, to measure basal and stimulated (120 min) pepsinogen-I levels after injection of pentagastrin.

RESULTS

H. pylori was eradicated in 26 patients (81%). Significant histologic improvement, in both the antrum and body, was observed (p < 0.001). Basal pepsinogen-I levels (mean and 95% confidence interval) at diagnosis and after eradication were 106 (92-119) and 87 (74-100) ng/ml, respectively (P < 0.001). Similarly, stimulated pepsinogen-I levels (integrated values) decreased from 4790 (4199-5381) before therapy to 3970 (3383-4557) ng/ml.min after eradication (P < 0.001). Pepsinogen I levels did not change in patients in whom H. pylori was not eradicated. The area under the receiver operating characteristic curve for decreased basal and stimulated pepsinogen-I levels was 0.77 (SE, 0.09) and 0.79 (SE, 0.1), respectively.

CONCLUSION

H. pylori eradication in duodenal ulcer patients was associated with a significant decrease in basal and stimulated pepsinogen-I levels. Measurement of these levels could determine how successful response to therapy has been in both the eradication and resolution of associated gastritis. Other advantages of this procedure are that it has low cost and results are evident at an early stage.

Helicobacter pylori, pepsinogens and gastrin: relationship with age and development of atrophic gastritis

BACKGROUND

Helicobacter pylori causes chronic gastritis in all infected individuals and thus may be a risk factor for the ultimate development of trophic gastritis and gastric cancer. The serum levels of pepsinogen A, pepsinogen C and gastrin can be used as markers for both non-atrophic and atrophic gastritis.

METHODS

We determined the serum levels of gastrin, pepsinogen A and pepsinogen C and the pepsinogen A/C ratio in 150 H. pylori-negative and 186 H. pylori-positive individuals.

RESULTS

The H. pylori infected patients had significantly higher serum levels of pepsinogen A, pepsinogen C and gastrin and a significantly lower pepsinogen A/C ratio. In the non-infected patients, none of the respective serum values changed with increasing age. In contrast, in the infected patients, the pepsinogen A level and pepsinogen A/C ratio decreased significantly with increasing age.

CONCLUSION

H. pylori infection increases serum levels of pepsinogen A, pepsinogen C and gastrin and decreases the pepsinogen A/C ratio. In infected subjects, levels of pepsinogen A and the pepsinogen A/C ratio decrease with ageing. These findings support the concept of H. pylori as a risk factor for the development of atrophic gastritis.