Abstract P6-06-02: Low expression levels of hormone receptors (ER-α and PGR) in human breast cancer samples is significantly associated with high-grade human cytomegalovirus-IEA

Background: Breast cancer (BC) is the most common type of malignancy and second leading cause of cancer deaths in women worldwide. While contemporary breast cancer therapy allows many patients with localized breast cancer to be cured for their disease, subgroups experience non-curable distant metastasis. In addition, majority of BC cases are considered to be "sporadic", with unknown underlying mechanisms. Thus, it is of major importance to investigate alternative factors that may initiate or promote human breast cancer. Recently, human cytomegalovirus (HCMV) has been detected in samples from primary BC, sentinel lymph nodes and brain metastases obtained from breast cancer patients. However, the oncomodulatory role of HCMV in BC is unknown. Accordingly, the purpose of this study was to elucidate possible correlations between expression of HCMV proteins and established histopathological markers (ER-α, PgR, HER2 etc.) in human breast cancer tissues. Material and Methods: Paraffin embedded breast cancer biopsies (n=62), ductal carcinoma in-situ (DCIS, n=18) and adjacent, benign breast tissue samples (n=42) were retrospectively examined for HCMV-immediate early (IE) and late (LA) proteins by using immunohistochemical techniques. Clinical data were available from the patients´ hospital files provided from the departments of oncology and pathology at Akershus University Hospital, Norway. All patients underwent direct surgery in 2011. The median age at time of surgery was 55 years. All patients received standard adjuvant treatment according to the Norwegian guidelines. Results: HCMV-IE was detected at different levels in all BC cases, DCIS and benign breast tissue samples. Interestingly, high grade HCMV-IE (defined as >50% positive cells in the tumor tissues) was detected in 77% of infiltrating BC and in 39% of DCIS and merely in 7% benign breast tissue samples. High grade HCMV-IE was detected in 40%, 76% and 83% of BC patients with >50-90%, >10-50% and <10% tumor cells expressing PgR in their tumors, respectively (p=0.003). All BC samples with negative or low (0-10%) positive staining for estrogen receptors (ER-α) showed high-grade HCMV-IE staining. In subgroups of patients with increasingly positive staining for ER-α between 10-50% and >50-90% of tumor cells, high HCMV-IE was found in 86% and 74%, respectively (p=0.02). A trend but no significant correlation was found between high-grade HCMV-IE and HER2 negativity (p=0.09). In contrast, High grade HCMV-LA proteins were detected in 5%, 11% and 3% of adjacent benign breast samples, DCIS and infiltrating BC, only. Conclusion: Our findings demonstrate that HCMV- IE but not HCMV-LA proteins are frequently detected in samples obtained from infiltrating BC and DCIS. Although the role of HCMV in carcinogenesis of BC is not defined, our findings suggest a negative correlation between high grade HCMV-IE and hormone receptors in general. All in all, our findings may indicate a possible oncomodulatory role of HCMV-IE in human BC, hampering the expression of hormone receptors and forcing the BC cells to a more aggressive phenotype. The effects of HCMV-induced proteins in human breast cancer cells should be investigated further.Background: Breast cancer (BC) is the most common type of malignancy and second leading cause of cancer deaths in women worldwide. While contemporary breast cancer therapy allows many patients with localized breast cancer to be cured for their disease, subgroups experience non-curable distant metastasis. In addition, majority of BC cases are considered to be "sporadic", with unknown underlying mechanisms. Thus, it is of major importance to investigate alternative factors that may initiate or promote human breast cancer. Recently, human cytomegalovirus (HCMV) has been detected in samples from primary BC, sentinel lymph nodes and brain metastases obtained from breast cancer patients. However, the oncomodulatory role of HCMV in BC is unknown. Accordingly, the purpose of this study was to elucidate possible correlations between expression of HCMV proteins and established histopathological markers (ER-α, PgR, HER2 etc.) in human breast cancer tissues. Material and Methods: Paraffin embedded breast cancer biopsies (n=62), ductal carcinoma in-situ (DCIS, n=18) and adjacent, benign breast tissue samples (n=42) were retrospectively examined for HCMV-immediate early (IE) and late (LA) proteins by using immunohistochemical techniques. Clinical data were available from the patients´ hospital files provided from the departments of oncology and pathology at Akershus University Hospital, Norway. All patients underwent direct surgery in 2011. The median age at time of surgery was 55 years. All patients received standard adjuvant treatment according to the Norwegian guidelines. Results: HCMV-IE was detected at different levels in all BC cases, DCIS and benign breast tissue samples. Interestingly, high grade HCMV-IE (defined as >50% positive cells in the tumor tissues) was detected in 77% of infiltrating BC and in 39% of DCIS and merely in 7% benign breast tissue samples. High grade HCMV-IE was detected in 40%, 76% and 83% of BC patients with >50-90%, >10-50% and <10% tumor cells expressing PgR in their tumors, respectively (p=0.003). All BC samples with negative or low (0-10%) positive staining for estrogen receptors (ER-α) showed high-grade HCMV-IE staining. In subgroups of patients with increasingly positive staining for ER-α between 10-50% and >50-90% of tumor cells, high HCMV-IE was found in 86% and 74%, respectively (p=0.02). A trend but no significant correlation was found between high-grade HCMV-IE and HER2 negativity (p=0.09). In contrast, High grade HCMV-LA proteins were detected in 5%, 11% and 3% of adjacent benign breast samples, DCIS and infiltrating BC, only. Conclusion: Our findings demonstrate that HCMV- IE but not HCMV-LA proteins are frequently detected in samples obtained from infiltrating BC and DCIS. Although the role of HCMV in carcinogenesis of BC is not defined, our findings suggest a negative correlation between high grade HCMV-IE and hormone receptors in general. All in all, our findings may indicate a possible oncomodulatory role of HCMV-IE in human BC, hampering the expression of hormone receptors and forcing the BC cells to a more aggressive phenotype. The effects of HCMV-induced proteins in human breast cancer cells should be investigated further.

Citation Format: Rahbar A, Touma J, Costa H, Davoudi B, Vetvik K, Geisler J, Söderberg Naucler C. Low expression levels of hormone receptors (ER-α and PGR) in human breast cancer samples is significantly associated with high-grade human cytomegalovirus-IEA [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-06-02.

Abstract P6-06-01: High-grade human cytomegalovirus IEA is associated with expression of COX-2 and 5-LO in human breast cancer samples

Background: The role of cyclooxygenase-2 (COX-2) in breast cancer development and progression has been supported by an increasing number of studies that show the overexpression of COX-2 in all the stages of the disease but in particular, in the metastatic phase. Besides COX-2 and its derived metabolites, 5-lipoxygenase (5-LO) and leukotrienes have also been associated with cancer progression. Human Cytomegalovirus (HCMV) detection in samples from primary BC, sentinel lymph nodes and brain metastases obtained from breast cancer patients' suggests that viral infection may also have a critical role in the development of breast cancer metastasis. Interestingly, in vitro studies showed that HCMV infections induce COX-2 in human fibroblasts, which augments viral replication through a prostaglandin dependent pathway. Thus, our main objective was to investigate whether there is a correlation between HCMV infection and overexpression of COX-2 and 5-LO in breast cancer. If so, HCMV could be an important additional target for breast cancer treatment.

Material and Methods: Paraffin embedded breast cancer biopsies (n=48), ductal carcinoma in-situ (DCIS, n=14) and adjacent, benign breast tissue samples (n=29) were retrospectively examined for HCMV-immediate early (IE), HCMV-Late (LA) proteins, COX2 and 5LO by using immunohistochemical techniques established in our laboratory. Clinical data were available from the patients´ hospital files provided from the departments of oncology and pathology at Akershus University Hospital, Norway. All patients underwent direct surgery in 2011. All patients received standard adjuvant treatment according to the Norwegian guidelines. For in vitro studies, breast cancer cell lines (MCF-7, MB-MDA-231 and SKBR3) were infected with HCMV VR1814 strain and levels of COX-2 and 5-LO were determined by qPCR and western blot and immunofluorescence.

Results: High levels of COX-2, 5-LO and HCMV-IE were detected mainly in breast cancer samples. High grade HCMV-IE (defined as >50% positive cells in the tumor tissues) was detected in 72% of infiltrating BC and in 28% of DCIS, but it was detected only in 7% of benign, adjacent breast tissue samples. Similarly, high grade COX-2 and 5-LO were detected in 58% and 53% of BC, in 21% and 8% of DCIS, and in 4% and 7% of benign, adjacent breast tissue samples, respectively. We found a statistically significant positive correlation for the levels of HCMV-IE and COX-2 (p=0.001) as well as for HCMV-IE and5-LO (p=0.0002) in infiltrating breast cancer. Furthermore, induction of COX-2 and 5-LO was confirmed in breast cancer cell lines following infection with HCMV was shown at both mRNA and protein level.

Conclusion: Our findings confirm a positive correlation of HCMV-IE protein synthesis and overexpression of COX-2 and 5-LO in infiltrating breast cancer, DCIS and benign, adjacent breast tissue samples, which is consistent with the up-regulation of these enzymes in breast cancer cells infected with HCMV. These results suggest that the inflammation driven by COX-2 and 5-LO in human breast cancer might be induced by HCMV infections and lead to tumor progression. Thus, anti-viral therapy should be considered as an additional experimental treatment in selected breast cancer patients.

Citation Format: Costa H, Touma J, Davoudi B, Geisler J, Vetvik K, Söderberg Naucler C, Rahbar A. High-grade human cytomegalovirus IEA is associated with expression of COX-2 and 5-LO in human breast cancer samples [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-06-01.

Islet cell autoantibodies in African patients with Type 1 and Type 2 diabetes in Dar es Salaam Tanzania: a cross sectional study

Background

The aim of the present study was to assess the occurrence of glutamic acid decarboxylase autoantibodies (GADA) and insulinoma antigen 2 autoantibodies (IA2A) among patients of African origin in Dar es Salaam, Tanzania and to compare the occurrence of autoimmune mediated Type 1 diabetes with findings previously reported from the same place and from other African diabetic populations.

Methods

Two hundred and forty five patients from the diabetic clinic at Muhimbili Hospital were recruited for a cross sectional study. Patients were clinically classified into groups with Type 1 (T1D) and Type 2 diabetes (T2D); there were 94 patients with T1D and 151 with T2D. Autoantibodies for GAD and IA2 were measured with an assay based on radioligand binding. Fasting and random blood glucose, HbA1c, and C-peptide levels were also determined.

Results

Of the patients with T1D, 28 (29.8%) were GADA positive and 20 (21.3%) were IA2A positive. The overall occurrence of any autoantibody was 42.6%. The GAD and IA2 autoantibodies were detected more frequently among patients with T1D than among patients with T2D (P < 0.001). A higher autoantibody prevalence was observed with combined GADA and IA2A measurements compared to individual autoantibody measurements; 40 (42.6%) patients with T1D versus 11 (7.3%) with T2D had at least one positive autoantibody titer. There was no correlation between duration of disease and detection of autoantibodies in patients with T1D. There was a strong association with family history of diabetes among the autoantibody positive versus autoantibody negative patients with T1D (p < 0.01).

Conclusion

The prevalence of GAD and IA2 autoantibodies among African patients with T1D in Dar es Salaam was the same as that reported previously for South Africa and Ethiopia. It was much higher than the prevalence of islet cell autoantibodies (ICA) reported from the same clinic about 15 years ago. For unknown reasons the prevalence of pancreatic related autoantibodies in this African population is lower than the prevalence found among Caucasian populations.

Microalbuminuria among Type 1 and Type 2 diabetic patients of African origin in Dar Es Salaam, Tanzania

Background

The prevalences and risk factors of microalbuminuria are not full described among black African diabetic patients. This study aimed at determining the prevalence of microalbuminuria among African diabetes patients in Dar es Salaam, Tanzania, and relate to socio-demographic features as well as clinical parameters.

Methods

Cross sectional study on 91 Type 1 and 153 Type 2 diabetic patients. Two overnight urine samples per patient were analysed. Albumin concentration was measured by an automated immunoturbidity assay. Average albumin excretion rate (AER) was used and were categorised as normalbuminuria (AER < 20 ug/min), microalbuminuria (AER 20–200 ug/min), and macroalbuminuria (AER > 200 ug/min). Information obtained also included age, diabetes duration, sex, body mass index, blood pressure, serum total cholesterol, high-density and low-density lipoprotein cholesterol, triglycerides, serum creatinine, and glycated hemoglobin A_1c.

Results

Overall prevalence of microalbuminuria was 10.7% and macroalbuminuria 4.9%. In Type 1 patients microalbuminuria was 12% and macroalbuminuria 1%. Among Type 2 patients, 9.8% had microalbuminuria, and 7.2% had macroalbuminuria. Type 2 patients with abnormal albumin excretion rate had significantly longer diabetes duration 7.5 (0.2–24 yrs) than those with normal albumin excretion rate 3 (0–25 yrs), p < 0.001. Systolic and diastolic blood pressure among Type 2 patients with abnormal albumin excretion rate were significantly higher than in those with normal albumin excretion rate, (p < 0.001).

No significant differences in body mass index, glycaemic control, and cholesterol levels was found among patients with normal compared with those with elevated albumin excretion rate either in Type 1 or Type 2 patients.

A stepwise multiple linear regression analysis among Type 2 patients, revealed AER (natural log AER) as the dependent variable to be predicted by [odds ratio (95% confidence interval)] diabetes duration 0.090 (0.049, 0.131), p < 0.0001, systolic blood pressure 0.012 (0.003–0.021), p < 0.010 and serum creatinine 0.021 (0.012, 0.030).

Conclusion

The prevalence of micro and macroalbuminuria is higher among African Type 1 patients with relatively short diabetes duration compared with prevalences among Caucasians. In Type 2 patients, the prevalence is in accordance with findings in Caucasians. The present study detects, however, a much lower prevalence than previously demonstrated in studies from sub-Saharan Africa. Abnormal AER was significantly related to diabetes duration and systolic blood pressure.

The Norwegian Gastronet project: Continuous quality improvement of colonoscopy in 14 Norwegian centres

OBJECTIVE

The burden on colonoscopy capacity is considerable and expected to increase further as colorectal cancer screening programmes gain a foothold in Europe. In this situation, it is particularly important to evaluate the quality of the service given. In this article we present our first year of experience with a quality network of endoscopy centres in Norway (Gastronet).

MATERIAL AND METHODS

A questionnaire focusing on caecal intubation rate and pain was completed by the endoscopist (on site) and patient (on the day after the examination). Fourteen centres participated with registration of 7370 colonoscopies by 73 endoscopists.

RESULTS

There was 100% endoscopist participation, 87% coverage of colonoscopies and an estimated 76% questionnaire coverage of the patient population. Overall caecal intubation rate was 91%, range 83% to 97% between centres (p < 0.001). Patients reporting severe pain during colonoscopy differed from 2 to 24% between centres (p < 0.001). Variations could only partly be explained by differences in procedure practice (sedation, CO2 insufflation). For individual endoscopists, improvement after feedback on performance was restricted to the group of endoscopists having contributed with only 50-99 registered colonoscopies.

CONCLUSIONS

In quality assurance programmes we recommend a limited number of variables for registration in order to secure high compliance by endoscopists and patients. One year of experience with Gastronet disclosed a satisfactory overall caecal intubation rate, but considerable variation between centres in practice and ability to offer painless colonoscopy. This suggests a need for formal, centralized training of colonoscopists or the development of quality standards for colonoscopy training and practice.

Esomeprazole 20 mg and lansoprazole 15 mg in maintaining healed reflux oesophagitis: Metropole study results

INTRODUCTION

Esomeprazole, the first proton pump inhibitor to be developed as an optical isomer, has demonstrated more effective healing vs. omeprazole and lansoprazole in patients with reflux oesophagitis (RO). However, RO recurs in a high proportion (approximately 80%) of these patients within 12 months of initial therapy, highlighting the importance of maintenance treatment. Previous studies have shown esomeprazole to be effective as maintenance therapy in healed RO patients.

AIM

This study was conducted to compare esomeprazole 20 mg once daily (o.d.) with lansoprazole 15 mg o.d. for the prevention of recurrence of RO.

METHODS

1391 patients with endoscopically verified RO (LA classification) were enrolled in this randomized, double-blind, parallel-group, multicentre trial. During the initial healing phase of the study, all patients received 4-8 weeks' open treatment with esomeprazole 40 mg: 1236 healed (identified by endoscopy at 4 and 8 weeks) and symptom-free (i.e. no heartburn or acid regurgitation) patients were randomized to 6 months' maintenance treatment with esomeprazole 20 mg o.d. or lansoprazole 15 mg o.d. Time to relapse (relapse of RO and/or discontinuation due to symptom recurrence) was analysed using a log-rank test.

RESULTS

Esomeprazole maintained a significantly higher proportion of patients in remission than lansoprazole over the 6-month course of treatment (P < 0.0001, intention-to-treat analysis). After 6 months' treatment, 83% of esomeprazole recipients were in remission compared with 74% of lansoprazole recipients (life-table estimates). Esomeprazole gave a longer time to relapse than lansoprazole irrespective of baseline LA Grade, significantly so for baseline LA Grades B, C and D (P < 0.05 for each comparison). Significantly more patients were free from heartburn in the esomeprazole group compared with the lansoprazole group at 1, 3 and 6 months (P < 0.05). Significant differences at 6 months between esomeprazole 20 mg o.d. and lansoprazole 15 mg o.d. were also observed for control of epigastric pain and acid regurgitation (P < 0.05 and P < 0.001, respectively). Both treatment regimens were well tolerated.

CONCLUSION

Esomeprazole 20 mg o.d. is a more effective maintenance treatment than lansoprazole 15 mg o.d. for symptom-free patients with healed RO.

Esomeprazole 20 mg and lansoprazole 15 mg in maintaining healed reflux oesophagitis: Metropole study results

AIM

To compare the efficacy of esomeprazole, 20 mg once daily, vs. lansoprazole, 15 mg once daily, for the maintenance treatment of patients with healed reflux oesophagitis.

METHODS

During the initial open healing phase, 1391 patients with endoscopically verified reflux oesophagitis and a history of heartburn, with or without acid regurgitation, received esomeprazole 40 mg for 4-8 weeks. Patients who were healed (identified by endoscopy at 4 or 8 weeks) and symptom free were then randomized to receive 6 months of treatment with esomeprazole, 20 mg once daily, or lansoprazole, 15 mg once daily.

RESULTS

Esomeprazole, 20 mg once daily, maintained a significantly higher proportion of patients in remission than lansoprazole, 15 mg once daily, over 6 months [83% (95% CI, 80-86%) of esomeprazole recipients compared with 74% (95% CI, 70-78%) of lansoprazole recipients; P < 0.0001; life table estimates]. When data were analysed according to baseline Los Angeles grade classification, esomeprazole, 20 mg once daily, achieved consistently higher remission rates across all grades of disease severity, whereas the efficacy of lansoprazole decreased to a greater extent with increasing severity of reflux oesophagitis.

CONCLUSION

Esomeprazole, 20 mg once daily, is more effective than lansoprazole, 15 mg once daily, in maintaining remission in patients with healed reflux oesophagitis.

Bone density reduction in patients with Crohn disease and associations with demographic and disease variables: cross-sectional data from a population-based study

BACKGROUND

The extent of bone density reduction in patients with Crohn disease is still being debated. The aim of this study was to examine bone mineral density (BMD) and factors associated with reduced BMD in a representative population of patients with Crohn disease aged between 20 and 70 years.

METHODS

BMD (using dual energy X-ray absorptiometry) was measured in spine and hip in 55 patients with Crohn disease recruited from the entire Crohn population (n = 96) in a defined area of southern Norway. Demographic and clinical data were also collected. The patients were compared with 52 age- and gender-matched healthy controls. Potential demographic and disease-related factors associated with BMD reduction were statistically tested with bi- and multivariate analyses.

RESULTS

The BMD reduction in patients with Crohn disease was 7.1% (P = 0.02) in spine L1-4, 6.1% (P = 0.08) in femoral neck and 8.4% (P = 0.02) in total hip as compared with the controls. In total hip and femoral neck, age, body weight and gender were independently associated with reduced BMD, but in the spine only body weight. Among the disease-related variables, only ever use of prednisolone was independently associated with reduction in BMD but this only in the femoral neck.

CONCLUSIONS

The spine and hip BMD reduction of 6%-8% is similar to that found in a comparable population-based study performed in another area in Norway. Among the disease-related variables tested for, only the use of prednisolone was independently associated with BMD reduction. However, the BMD reduction measured in this study indicates that disease-related mechanisms are involved.

[Acid-related disease in the population of two Norwegian municipalities--diagnosis and drug therapy]

BACKGROUND

The introduction of acid suppressant, cytoprotective and prokinetic drugs represented major progress in the treatment of acid-related diseases. In Norway, these drugs were reimbursed by the National Insurance System (NIS) from 1986. However, even if the distribution of the various diagnostic indications for prescribing were lacking, this reimbursement was stopped in 1995. The aim of this study was to describe prescriptions for presumed licensed diagnostic indications of these drugs for a defined population, and analyse them with regard to patients characteristics, verified (endoscopic) diagnoses, and therapeutic guidelines.

MATERIAL AND METHODS

All prescriptions issued in 1994 to inhabitants of Lindesnes and Mandal Municipalities (17,105 inhabitants) were retrospectively retrieved from the pharmacies and the NIS. The medical records of the local endoscopy units and roentgen laboratories were subsequently searched for information on diagnostic procedures and final diagnosis leading to the prescriptions for these patients.

RESULTS

A total number of 1,128 prescriptions (87,905 DDDs) were issued to 441 patients (3% of the population at risk; mean age 63 years; 55% men), and more commonly for the elderly (for 11% of those aged 80 years or more). Diagnostic procedures were documented for 93% of the patients (upper endoscopy in 404, 92%). Diagnostic indications for prescribing were reflux oesophagitis (48%), duodenal ulcer (24%), gastric ulcer (13%), and dyspepsia with normal endoscopic findings (12%). The drugs issued were H2-receptor antagonists (59%), proton pump inhibitors (31%), and cisapride (10%). 8% of the patients were long-term users of an NSAID. Of the 441 patients, drug treatment was issued to 38 with normal endoscopic findings and to 31 patients in whom we could not document examination by endoscopy or X-ray.

INTERPRETATION

This study supports that the prevalence of dyspeptic complaints calling for drug treatment increases with patient age. With minor exceptions we found that the prescribing practice for the different diagnoses is in accordance with established therapeutic guidelines.

Effects of omeprazole and eradication of Helicobacter pylori on gastric and duodenal mucosal enzyme activities and DNA in duodenal ulcer patients

BACKGROUND

Duodenal and gastric content of mucosal enzymes in duodenal ulcer (DU) patients differs from that of controls. The purpose of this study has been to examine the effect of omeprazole and eradication of Helicobacter pylori on mucosal enzymes in DU patients.

METHODS

The enzyme activities of seven gastric and duodenal mucosal marker enzymes from the brush border, lysosomes, and mitochondria have been studied. In study I the measurements were made in 29 patients with an active DU before and after 14 days of omeprazole treatment. In study II 22 duodenal ulcer patients were given bismuth subnitrate, oxytetracycline, and metronidazole (triple therapy) for 2 weeks to eradicate H. pylori. Biopsy specimens were taken from the duodenum and the stomach for enzyme measurements and histologic assessment. In study II additional specimens were obtained from the prepyloric region for urease tests and culture of H. pylori.

RESULTS

The ulcer healing rates were more than 90% after both omeprazole and triple therapy. H. pylori was eradicated in 86% after triple therapy. The activities of the brush-border enzymes lactase, neutral-alpha-glucosidase, alkaline phosphatase, leucyl-beta-naphthylamidase, and gamma-glutamyltransferase (gamma-GT) increased significantly in the duodenal bulb and the descending duodenum during treatment with omeprazole. No changes in duodenal enzyme activity were detected after triple therapy, whereas a significant fall in gamma-GT and acid phosphatase activities was seen in the stomach. The mucosal DNA in the gastric antrum decreased both after treatment with omeprazole and after triple therapy.

CONCLUSIONS

A similar decrease in mucosal DNA of the gastric antrum was demonstrated after both omeprazole and triple therapy with bismuth subnitrate, oxytetracycline, and metronidazole. Omeprazole also affects the content of duodenal mucosal enzymes, whereas triple therapy particularly affects the gastric mucosal enzyme activity.

Helicobacter-associated duodenitis and gastric metaplasia in duodenal ulcer patients

Biopsy specimens were taken from the duodenal bulb and the distal duodenum in 45 duodenal ulcer patients before and after treatment with histamine-2 antagonists, prostaglandin analogues or antacids. After four weeks of treatment, the ulcer had healed in 31 patients. The treatment did not lead to a reduced frequency of helicobacter-associated duodenitis or gastric metaplasia of the duodenal epithelium. We found gastric metaplasia in 52.3% of all biopsy specimens from the duodenal bulb, chronic active duodenitis in 71.9% and helicobacter-like structures in 15.9%. The helicobacter organisms were found only in areas of gastric metaplasia, and an accompanying chronic active duodenitis was found in 94.1%. In the distal duodenum, we observed chronic active duodenitis in 15.0% of the specimens. Here the inflammation was not associated with gastric metaplasia or helicobacter-like structures. These observations support the hypothesis that Helicobacter pylori colonizes the duodenal mucosa only in areas of gastric metaplasia, and that such colonization may lead to an active duodenitis.

Helicobacter pylori and chronic active inflammation of the duodenum and stomach in duodenal ulcer patients treated with ranitidine, misoprostol, or an acid-neutralizing agent

Biopsy specimens from the stomach and duodenum of 45 duodenal ulcer patients treated with ranitidine, misoprostol, or an antacid were examined. During 4 weeks of treatment the duodenal ulcer healed in 31 patients. The treatment regimens showed no significant effect on the amount of Helicobacter-like structures (HLS) or the presence of active inflammation, either in the stomach or in the duodenum. All patients had chronic active antral gastritis before and after treatment. HLS were found histologically in 91.7% of all antral specimens, in 94.2% of the gastric corpus specimens, in 15.9% of the duodenal bulb specimens, and in 0.9% from the lower duodenal knee. The frequency of chronic active gastritis was clearly lower in the gastric corpus than in the antrum, whereas the occurrence of HLS was about the same. This may indicate a higher resistance of the gastric corpus mucosa to H. pylori.

Effect of misoprostol and antacids on gastric and duodenal mucosal enzyme activities in duodenal ulcer patients

The activities of 11 marker enzymes from the gastric and duodenal mucosa were determined in 15 patients with active duodenal ulcer disease before therapy, after 4 weeks of therapy with the prostaglandin E1 analogue misoprostol, 400 micrograms twice daily, and after another 4 weeks without any therapy. Another 15 patients were given a high-dose liquid antacid regimen. The activities were measured in homogenized material obtained with forceps through an endoscope. The healing rates of the two groups at 4 weeks were 53% and 80%, respectively. No changes in mucosal inflammation were noted during therapy. During treatment with misoprostol the activities in the descending duodenum of the membrane enzymes alkaline phosphatase, leucyl-beta-naphthylamidase, gamma-glutamyltransferase, and 5'-nucleotidase increased towards the values seen in normal controls. Despite a higher healing rate, no changes in the enzyme activities occurred in the group given high-dose antacid therapy. Four weeks after cessation of therapy the enzyme activities in the misoprostol group were not significantly different from the pretreatment values. In the biopsy specimens from the duodenal bulb the activities of monoamine oxidase fell during treatment with misoprostol and were restored to the pretreatment activity when therapy was stopped. In the stomach mucosa the enzyme activities were largely unchanged during treatment with both misoprostol and antacids. These results indicate that misoprostol and antacids have different mechanisms of action but may also suggest that the demonstrated enzymic changes are unrelated to the healing process.

Effect of ranitidine on gastric and duodenal mucosal enzyme activities in duodenal ulcer patients

The activities of 11 marker enzymes from the gastric and duodenal mucosa were determined in 19 patients with active duodenal ulcer disease (DU) before therapy, after 4 weeks of therapy with ranitidine, 300 mg/day, and after another 4 weeks without treatment. The activities were measured in homogenized material obtained with forceps through an endoscope. The healing rate at 4 weeks was 68%. In the descending duodenum the activities of the membrane enzymes increased during the treatment period compared with pre-treatment activities. Although not as extensive as in the descending duodenum, an increase of membrane enzyme activities was also noted in the duodenal bulb during treatment. In the gastric mucosa only minor enzymic activity changes were seen. The altered enzyme activities in duodenum and stomach during treatment were independent of ulcer healing, smoking, antacids, and mucosal inflammation. Previously, significant differences in mucosal enzyme activities have been demonstrated between DU patients and controls. During ranitidine treatment the enzyme activities in the duodenal mucosa of the same DU patients tended to normalize, whereas they were mostly unchanged in the gastric mucosa. Four weeks after treatment the mucosal enzyme activities in the duodenum were as before treatment started, without occurrence of ulcer relapse. The altered enzymic activities of the duodenal mucosa in DU patients therefore seem to be largely independent of the presence of active ulcer.

Enzyme activities in the gastric mucosa in duodenal ulcer patients

In a series of 45 consecutive duodenal ulcer patients (DU) the activities of 10 marker enzymes from the brush border, basolateral membrane, mitochondria, and lysosomes were determined by analysis of homogenized material taken with biopsy forceps through an endoscope from the antral and body part of the stomach. They were compared with the enzyme activities determined in controls with similar types of gastritis but without any evidence of peptic ulcer disease. All the DU patients had gastritis in the antral mucosa. In the body part, about 30% had gastritis. In the antral mucosa of DU patients the activities of the membrane and lysosomal enzymes were mostly increased when compared with the controls. In the gastric body mucosa of DU patients the activities of the lysosomal enzymes were mostly increased, whereas most of the membrane enzymes showed unchanged activities when compared with the corresponding controls. Monoamine oxidase activities were decreased or unaltered in both regions in these patients. The finding of enzymatic changes in the gastric mucosa of DU patients gives further support to an altered mucosal metabolism in these patients.

Enzyme activities in the duodenal mucosa in duodenal ulcer patients

The mucosal enzyme activities of 11 marker enzymes from the brush border, basolateral membrane, and lysosomes of 45 patients with an active duodenal ulcer (DU) were determined by analysis of homogenized biopsy specimens obtained from the duodenal bulb and descending duodenum at endoscopy. They were compared with activities measured in 22 controls. In the duodenal bulb lactase (p less than 0.005), neutral-alpha-glucosidase (p less than 0.0005), and monoamine oxidase (p less than 0.0005) were significantly decreased in DU patients. In the descending duodenum all the brush border enzymes except sucrase were significantly decreased when compared with controls. DU patients with inflammation in the biopsy specimens from the duodenal bulb had decreased levels of lactase (p less than 0.05), sucrase (p less than 0.05), neutral-alpha-glucosidase (p less than 0.05), leucyl-beta-naphthylamidase (p less than 0.05), and acid phosphatases (p less than 0.05) when compared with DU patients with normal histology in this region. In the descending duodenum the activities of leucyl-beta-naphthylamidase (p less than 0.05) were decreased in patients with inflammation compared with those without such histologic changes. DU patients who had taken antacids before the investigation had decreased activities of lactase (p less than 0.05) in the descending duodenum when compared with those who had not taken antacids. Activities of lactase (p less than 0.005), sucrase (p less than 0.005), neutral-alpha-glucosidase (p less than 0.05), and acid beta-glucuronidase (p less than 0.0005) in the descending duodenum were significantly lower in smokers than in non-smokers with active DU.

Influence of remote cancer and obesity on, and distribution of mucosal enzymes in, the upper small intestine

A series of mucosal enzymes were estimated by analysis of homogenized biopsy specimens from the lower duodenal flexure, obtained from 10 large-bowel carcinoma patients, 15 patients with morbid obesity, and 15 controls. In 11 subjects the distribution along the upper small intestine was determined. The activities of the brush border enzymes lactase (p less than 0.01), neutral-alpha-glucosidase (p less than 0.01), and alkaline phosphatase (p less than 0.05) were significantly lower in the large-bowel carcinoma patients than in the controls. In obese subjects significantly lower activities (p less than 0.05) were demonstrated for the basolateral membrane enzyme 5'-nucleotidase and the lysosomal enzymes N-acetyl-beta-D-glucosaminidase and acid beta-glucuronidase, when compared with those in controls. Compared with the enzyme levels of the duodenal bulb, significantly higher activities of a series of enzymes were demonstrated at both the lower duodenal flexure and the angle of Treitz.

Chronic pancreatitis in patients with sclerosing cholangitis and ulcerative colitis

In the 4-year period 1980-83 sclerosing cholangitis was demonstrated in 7 out of 151 patients with ulcerative colitis hospitalized in our department. Total ulcerative colitis was demonstrated in all patients with sclerosing cholangitis, whereas abnormal pancreatograms compatible with chronic pancreatitis were seen in four of these patients. According to the criteria of Kasugai, one had minimal, two moderate, and one advanced changes of chronic pancreatitis. Although three of four patients had been treated with drugs known to induce pancreatitis (sulfasalazine and corticosteroids), it is tempting to assume that ulcerative colitis, sclerosing cholangitis, and pancreatitis, when seen in combination, are manifestations of autoimmune diseases with a genetic predisposition. A mechanical mechanism for the development of chronic pancreatitis in sclerosing cholangitis must also be considered.

Screening for occult faecal blood loss in a community by means of Hemoccult II slides and a tetramethylbenzidine test

A total of 754 persons statistically selected from the age group 54-64 years were asked by letter to provide faecal samples for screening of occult blood during dietary restrictions. A total of 413 persons (55%) returned an average of 5.8 (range, 1-6) faecal samples each. All the faecal specimens were analysed with Hemoccult II slides and the 3,3',5,5'-tetramethylbenzidine (TMB) test 0.10%. For technical reasons, however, the Hemoccult test could not be evaluated. The TMB test showed faecal blood in 50 persons. A case history was obtained in 49 persons, of whom 47 agreed to further clinical, radiological, and endoscopic investigations. The most important findings in these examinations were resectable colonic carcinoma (Dukes's stage B) in 1 subject, a gastric ulcer in 1, haemorrhagic gastritis in 1, duodenal ulcers in 2, and colorectal polyps in 11 persons. The cost of the study was estimated to be NOK 114,000 (about USD 16,000).