[Calcium and phosphorus balance and its significance for the course of recurrent peptic ulcer disease]

AIM

To evaluate calcium and phosphorus balances during recurrent peptic ulcer disease (PUD) and to estimate the impact of found changes on the course of an ulcerative process, secretory and motor functions in the stomach.

SUBJECTS AND METHODS

Sixty patients with recurrent PUD were examined. They underwent determinations of blood and urinary calcium and phosphorus levels and gastric secretory and motor functions in addition to clinical and endoscopic examinations.

RESULTS

Recurrent PUD was shown to be accompanied by significantly elevated blood calcium and substantially decreased blood phosphorus, insignificant hypercalciuria and hyperphosphaturia. These changes were attended by considerably increased acid- and pepsinogen-forming functions of the stomach, lower gastromucoprotein production, and gastric hypermotor dyskinesis. More pronounced shifts in calcium and phosphorus balance were revealed in the acute phase of a disease recurrence in young men with duodenal ulcers.

CONCLUSION

A clear relationship between calcium and phosphorus metabolic disturbances, ulcerative process activity, and gastric functional changes may point to the significance of found shifts in ulcerogenesis and to the pathogenetic substantiation of correction of these disorders in the treatment of a disease recurrence.

Recurrence of peptic ulcer in uraemic and non-uraemic patients after Helicobacter pylori eradication: a 2-year study

BACKGROUND

The role of Helicobacter pylori in the pathogenesis of peptic ulcer disease in patients with uraemia remains unclear.

AIM

To evaluate the long-term effect of H. pylori eradication in these patients.

METHODS

Uraemic and non-uraemic patients with peptic ulcer were enrolled in this study. Patients having history of non-steroidal anti-inflammatory drugs use or cardiovascular disease that need aspirin use were excluded. After confirmation of H. pylori infection, they received a triple therapy and were followed up for 2 years.

RESULTS

Between September 1999 and December 2005, 34 patients (41%) of the end-stage renal disease [H. pylori (+) group] and 67 (84%) of the non-uraemic patients with peptic ulcer disease (PU group) received anti-H. pylori therapy. After triple therapy, 32 (94%) from the end-stage renal disease group and 64 (96%) from the peptic ulcer group obtained successful eradication. During the 2-year follow-up, three patients in the end-stage renal disease group were excluded because of the presence of cardiovascular disease and aspirin use in two cases and died of heart failure in one case; two patients in peptic ulcer group refused follow-up. Finally, 29 uraemic and 62 non-uraemic patients had achieved the follow-up. Recurrence of peptic ulcer was more in the end-stage renal disease group than in the peptic ulcer group with intention-to-treat analysis (eight of 32, 25% vs. two of 64, 3%, P = 0.001, OR: 10.0, 95% CI: 1.979-50.540) or per-protocol analysis (eight of 29, 28% vs. two of 62, 3%, P < 0.001, OR: 11.4, 95% CI: 2.245-58.168).

CONCLUSIONS

Peptic ulcer recurrence after H. pylori eradication is higher in end-stage renal disease patients with peptic ulcer than in peptic ulcer patients without renal disease. Factors aside from H. pylori play an important role in peptic ulcer recurrence in end-stage renal disease patients.

Evaluation of an office-based urine test for detecting Helicobacter pylori: a Prospective Pilot Study

BACKGROUND/AIMS

To ascertain the reliability of a newly developed office-based urine test, the RAPIRUN test, used for detection of H. pylori infection.

METHODOLOGY

Urine specimens from 142 consecutive patients undergoing gastroendoscopy (77 men, 65 women; mean 52.0 years) were tested with RAPIRUN at the same time. The total reaction time for the urine test is 20 min. None of the patients had received any H. pylori eradicating treatment. The H. pylori status was evaluated based on 5 different tests: culture, histology, biopsy urease test, 13C-urea breath test, and the RAPIRUN test. A commercial office-based kit using an immunochromatographic technique was used to examine urine samples for H. pylori antibody. H. pylori status was defined as positive when the culture was positive or if 2 of the other 3 tests (histology, biopsy urease test, and 13C-urea breath test were positive.

RESULTS

Of 93 patients with H. pylori infection, 88 were tested as positive by RAPIRUN (sensitivity 94.6%). Of 48 patients without infection, 43 were found to be negative by RAPIRUN (specificity 89.6%). One case with an invalid urine test was excluded.

CONCLUSIONS

This urine test is a rapid, inexpensive, reliable and easy-to-use tool for the diagnosis of H. pylori infection in untreated patients. It can be used for mass screening of patients' H. pylori status, particularly in children, postgastrectomy patients, uncooperative patients, and patients undergoing bismuth or proton pump inhibitor treatment.

[The prenatal manifestations of peptic gastroduodenal diseases]

Proteolytic activity of uropepsinogen as a marker of gastroduodenal diseases of peptic character was studied in 92 children aged 7-9 years and it was analyzed in parallel with specific features of their mothers' pregnancy. The findings obtained and literature data show that the genotypical features of the fetus can play a certain role in genesis of the specific course of the mothers' pregnancy and manifest themselves phenotypically via the elevated level of uropepsinogen proteolytic activity in the children at the age of 7-9 years with possible formation of gastroduodenal diseases in them.

Altered urinary interleukin-8/creatinine ratio in peptic ulcer disease: pathological and diagnostic implications

OBJECTIVES AND METHODS

To assess its clinicopathological and diagnostic significance, interleukin-8 (IL-8) was measured by radioimmunoassay in fasting urine specimens and in gastric mucosal incubates taken from 54 patients with dyspepsia. The presence of Helicobacter pylori, the activity of gastritis, and urine creatinine levels were also assessed.

RESULTS

The median urinary IL-8/creatinine ratio was 0.1 x 10(-6) in patients with current peptic ulcers (n = 13) and 0.2 x 10(-6) in patients with a history of ulcers (n = 8), compared with 0.4 x 10(-6) (p < 0.0001) in patients without ulcers who were infected with H. pylori (n = 20) or not infected (n = 13). The activity of gastritis had a positive correlation with gastric IL-8 (r = 0.5870, p < 0.01) and a negative correlation with urinary IL-8/creatinine ratio (r = -0.6447, p < 0.005). The improvement in the activity of gastritis in 20 patients given anti-H. pylori triple therapy was associated with a significant fall in gastric mucosal IL-8 and a rise in urinary IL-8/creatinine ratio.

CONCLUSIONS

An inverse relationship seems to exist between urinary IL-8 and the activity of gastritis and gastric IL-8. This may represent another concept in the pathogenesis of peptic ulcers and can assist in the noninvasive diagnosis of peptic ulcer disease.

[Level of certain carbohydrate components in blood serum and urine of patients at extensive periods since suturing for perforated gastroduodenal ulcers]

The duration of gastric impairment before perforation as well as morphological features of sutured ulcer were shown to influence the protective functions of the gastric and duodenal mucosal membrane as shown by estimation of hexose, fucose and sialic acids in the blood serum and urine of 128 patients within later periods after suturing perforated gastroduodenal ulcers. Inhibition of the mucosal membrane protective functions in gastroduodenal tissues was increased with a longer disease period before perforation and with more distinct pathomorphological alterations of the perforated ulcer.

Homologous radioimmunoassay for human epidermal growth factor (urogastrone)

Epidermal growth factor (EGF), a polypeptide hormone originally discovered in the mouse submaxillary gland, stimulates growth in a variety of tissues in several species. This hormone has recently been identified in human urine. A homologous RIA for human EGF (RIA-hEGF) has been developed. In general, levels were similar to those recently reported using a heterologous RIA system. Twenty-four-hour urinary excretion of RIA-hEGF by normal adult males and females was 63.0 +/- 3.0 and 52.0 +/- 3.5 (mean +/- SE) micrograms/total vol, or 29.7 +/- 1.1 and 39.8 +/- 1.7 micrograms/g creatinine, respectively. Excretion by females taking oral contraceptives was significantly greater (60.1 +/- 2.7 micrograms/g creatinine; P less than 0.01) than that by females who were not. Recent evidence suggests the probable identity of hEGF and beta-urogastrone, a potent inhibitor of gastric acid secretion. Adult males with active peptic ulcer disease appeared to have lower urinary RIA-hEGF excretion (22.9 +/- 2.6 micrograms/g creatinine) than normal men, but this was not significant (P greater than 0.05). Several of those with very low values had histories of alcohol abuse. Excretion by patients with Cushing's syndrome was normal. Patients with psoriasis or recovering from major burns excreted both abnormally high and abnormally low levels of RIA-hEGF, with no obvious correlation to their clinical condition. There was no apparent diurnal or postprandial variation in urinary RIA-hEGF excretion by normal subjects. An excellent linear correlation was observed between RIA-hEGF and creatinine concentrations in each urine sample for each subject, suggesting that RIA-hEGF concentration in a random urine sample provides a valid index of 24-h RIA-hEGF excretion.

Urinary oxalate on a high-oxalate diet as a clinical test of malabsorption

100 g of spinach a day was added to the hospital diet of fifty-four patients with suspected malabsorption. Hyperoxaluria was found in thirty-eight patients; all of them had steatorrhoea. No patient with steatorrhoea had a urinary oxalate excretion of less than 40 mg a day. Ten other patients had hyperoxaluria, but the faecal fat determinations were regarded as unreliable in almost all and malabsorption could not be confirmed. It is suggested that in clinical practice determination of urinary oxalate after an oral load of oxalate could replace faecal fat determination in most patients with suspected malabsorption.

[Fucoglycoproteins in the biological fluids of relatives of peptic ulcer patients]

Comparative studies of 89 people originating from healthy families and of 103 relatives of patients with ulcerous disease revealed in the latter group more frequent occurrence of the O (I) group of blood, nonsecretory status as evidenced by ABH or secretion of group antigen "H", an increase in content of high molecular fucoglycoproteins in blood serum and increased urinary excretion of fucoglycopeptides. The data obtained suggest that impairment of secretion of fucoglycoproteins in ulcerous disease is hereditary determined; the impairment may faster development of chronic ulcer in the gastroduodenum due to weakening of the barrier function of the system