Could chronic peptic ulcers be localised areas of acid susceptibility generated by autoimmunity?

Autoimmune reactions to gastric mucosa in chronic gastritis: a review

The main results of two-decade co-operation between Tartu University, Estonia, and the University of Helsinki, Oulu and Tampere in Finland on immunology of chronic gastritis are presented. These results include data on cell-mediated and humoral immunity to autoantigens from gastric antrum and corpus mucosa in chronic gastritis, gastric ulcer, gastric carcinoma and other gastric diseases, as well as in random samples from two populations.

The occurrence of gastric and duodenal auto-antibodies in peptic ulcer disease

The possible relationship between peptic ulcer and the occurrence of auto-antibodies was investigated by means of an enzyme-linked immunosorbent assay (ELISA). Sera from 24 patients with active duodenal ulcer were analysed using cells and subcellular fractions from pig gastric acid duodenal mucosa for binding of immunoglobulins. Four sera (17%) reacted with a homogenate from duodenal mucosa. Nine sera (38%) were found to contain auto-antibodies against gastric mucosal cells. The cell-reactive auto-antibodies were shown to bind preferentially to parietal cells and chief cells. In these cells the antigens were identified as H, K-ATPase and pepsinogen respectively. Six sera were positive against purified H,K-ATPase; 12 sera were positive against pepsinogen, and only one of these sera reacted with both H,K-ATPase and pepsinogen. The results show that auto-antibodies are formed in a large fraction of patients (18/24; 75%) with peptic ulcer disease. The present study further demonstrates that enrichment of antigenic structures is required for obtaining a satisfactory sensitivity in the assay.

Herpes simplex and duodenal ulcer pathology

An association between Herpes simplex Virus 1 (HSV-1) and duodenal ulcer disease has been suggested. Duodenal ulcers, like HSV-1 lesions, exhibit periodicity in recurrence. Several of the presently available anti-ulcer agents may have an antiviral action. Antibody titres in some studies have shown selective increases to HSV-1 in duodenal ulcer patients. The aim of this study was to determine whether a real association exists between HSV-1 and endoscopically proven duodenal ulcer or duodenal erosive disease. In a prospective study, 27 patients with either duodenal ulcer (16) or duodenal erosions (11) were studied in order to attempt isolation of HSV-1. Acute and convalescent sera were also taken and examined by an enzyme linked-immunoabsorbent assay system for antibody titres to HSV-1. Duodenal biopsies from a further 26 patients with duodenal ulcer or erosive disease were also examined retrospectively for HSV-1 by the immunoperoxidase technique. In no case of either duodenal ulcer or duodenal erosive disease was HSV-1 isolated by any of the above methods, nor was a relationship demonstrated by acute or convalescent HSV-1 antibody titres. Hence, this study does not support an association between HSV-1 and duodenal ulcer or erosive disease.

Gastric cell c-AMP stimulating autoantibodies in duodenal ulcer disease

Gastric cell c-AMP stimulating antibodies (GCS-Ab) were studied in 30 patients with duodenal ulcer (DU) disease. Semipurified immunoglobulin (Ig) preparations from 13/30 patients stimulated c-AMP production in parietal cell enriched gastric cell suspensions obtained from male guinea pig stomachs. Maximum stimulation (varying between 260 and 547%) was reached after four hours incubation with 2 and 4 mg/ml Ig concentrations. The 13 patients with gastric cell stimulating antibodies (GCS-Ab), all male patients, developed the disease at a younger age (nine of 13 under the age of 30), had a longer duration of symptoms (mean 18.4 years), and had a higher incidence of DU in their families (61%). Eight of 13 (61%) in the GCS-Ab+ group did not respond to anti-H2-R drugs, whereas in the negative patients only three of 17 (18%) were classified as 'non-responders'. Remarkably few conventional autoantibodies were detected in our series. Gastric cell stimulating antibodies are a new addition to the growing list of receptor antibodies in human diseases and the described in vitro test should provide an easier tool for screening large populations.