Gastric Complaints Research Articles

Helicobacter pylori antibodies in sera of children suffering from chronic abdominal pain

107 pediatric patients aged 9 to 18 with persistent gastric complaints were examined serologically and bacteriologically for Helicobacter pylori. Helicobacter was identified in 48 (45%) of individuals. 51 (48%) of children were found to be seropositive when H. pylori antibodies were detected by the ELISA; 56 (52%) when the passive haemagglutination test was used, and 41 (38%) in the latex agglutination test. 25% of culture-negative patients were found to be seropositive. The percentage of raised H. pylori antibody titres in the control (healthy subjects) varied from 20 to 27%, depending on the method applied.

Randomized, double-blind study of the efficacy and tolerability of proglumetacin versus diclofenac in sports trauma

In a randomized, parallel-group study, 44 young adults with acute ankle sprains were treated with proglumetacin or diclofenac. The patients were examined daily for pain, swelling, and impaired mobility during the 7-day treatment period. The needed duration of physical therapy and the length of the break from sports activities were determined after the patients completely recovered. The clinical results showed that proglumetacin's efficacy was significantly greater and faster than that of diclofenac, especially on pain and swelling. Fewer gastric complaints were reported with proglumetacin than with diclofenac.

EARLY RECOGNITION OF CHEMICAL DEPENDENCE

Chemical dependence is a leading cause of morbidity and death in the United States. At least 20% of patients seen by primary care physicians in both the outpatient and inpatient setting are chemically dependent. Up to 90% of these patients go undiagnosed by their primary physicians. Chemical dependence is defined as a chronic, progressive illness characterized by the repeated and persistent use of alcohol or drugs despite negative health, family, work, financial, or legal consequences. Primary care physicians are in an ideal position to detect chemical dependence at its earliest stages, when irreversible medical consequences and death are most likely preventable. Alcohol is the most common drug of abuse. Improving the rate of recognition of chemical dependence depends on being familiar with the constellation of physical, mental, and social indicators. Early medical manifestations of alcoholism common in the primary care setting include: gastric complaints, elevated blood pressure, palpitations, traumatic injuries, headaches, impotence, and gout. Early psychosocial manifestations common in both alcohol and drug dependence include anxiety, depression, insomnia, persistent relationship conflicts, work or school problems, and financial or legal problems. Particularly useful laboratory indicators of alcoholism include elevated levels of GGT and MCV, both displaying high specificity, with the GGT level being the most sensitive. Similarly specific laboratory tests for drug dependence are not available. Any patient presenting with any of the above medical, psychosocial, or laboratory manifestations should be screened for chemical dependence. The CAGE questionnaire for alcoholism, a four-question test, is particularly well suited to the primary care setting, where it can be administered in fewer than 60 seconds. The CAGE has demonstrated high sensitivity (in the 80% range) and specificity (approximately 85%) for alcoholism. Comparably convenient instruments do not yet exist for drug dependence, although a 28-item instrument, the DAST (Drug Abuse Screening Test), has demonstrated high sensitivity and specificity for drug abuse.

Is There a Typical Conflict in Gastric Complaints?

The question of conflict specificity for subjects with gastric complaints was investigated in the context of a representative, epidemiologic-psychoanalytic field study. Out of a population of 600 adults probands with dyspepsia were compared with individuals with musculoskeletal symptoms and 'healthy' subjects. Using interview protocols 2 'blinded' raters judged whether a dependency-independency conflict was present in different aspects of life. Findings supported the higher prevalence of the conflict among subjects with dyspepsia. Therefore, the conflict was considered typical, but not specific for the experimental group.

PREVALENCE OF ANTIBODIES TO HELICOBACIER PYLORI (Hp) IN CHILDREN WITH RECURRENT ABDOMINAL PAIN (RAP)

Recent studies relied on both invasive (endoscopy and biopsy) and noninvasive (serology) diagnostic procedures linve suggested that Hp is a possible cause of RAP in older children and adolescents. It has, however, been argued that serologic testing cannot yet be extondexl to younger subjects, as the age may influence immune response to Hp. We report ttie serologic findings of a prospective study in which IgG antibodies to Hp were measured by a quantitative ELISA (Helico-G, Porton Cambridge)in 45 children (mean age 7.6 years) with recurrent boats of abdominal pain for at least 3 months, as well as in 60 age-matched healthy children with no history of gastric or intestinal complaints. Serum samples were also obtained from 18 parents of children with Hp-associated RAP and 25 parents of age-matched control. A cut off 10 U/ml appeared none appropriate for screening our population, giving a sensitivity of 86.8% aid a specificity of 92.8% when tested on 41 sera obtained frcm children with known histologic Hp status. Fifteen (33.3% of RAP patients were seropositive (median, 18 U/ml), while only 4 (4.4%) of the contiol group showed high antibody titers; (median, 18.9 U/ml). Of 18 parents of seropositive children with RAP and 25 parents of seronegative healthy children, 12 (68%) and 6 (24%) had positive serologic results, respectively.Our data show with systemic immune response to Hp may also be fully established in younger children with RAP. Intrafamiliar spread of Hp may explain the high prevalence of seropositivity among these patients. A definitive answer to the clinical relevance of lip antibodies in children with RAP will require further studies.

Helicobacter colonization and histopathological profile of chronic gastritis in patients with or without dyspepsia, mucosal erosion and peptic ulcer: a morphological approach to the study of ulcerogenesis in man.

Helicobacter pylori colonization and the incidence, severity, activity and topography of gastritis were investigated systematically in antrum and corpus mucosal biopsies of 1177 subjects undergoing endoscopy in the absence of gastric complaints (asymptomatic, 49) or for non-ulcer dyspepsia (NUD; 631 patients, 72 of whom had gastric and/or duodenal erosions), active gastric ulcer (GU, 76 patients), active duodenal ulcer (DU, 138 patients), and healed gastric (HGU, 39 cases) or duodenal ulcer (HDU, 230 cases). In the antrum, H. pylori colonization and the incidence, severity and activity of gastritis increased progressively in the sequence asymptomatic, erosion-free NUD, erosive NUD, healed ulcer and active ulcer. The same trend was observed in the corpus as regards H. pylori and gastritis incidence, whereas the severity and activity of gastritis were lower in active DU and erosive NUD and higher in active, proximal GU than in the remaining patients. Active DU and erosive NUD showed the highest incidence of non-atrophic gastritis and lowest type-A or AB atrophic gastritis, while active GU had lowest normal mucosa or type-A gastritis and highest type-B atrophic gastritis. In conclusion, H. pylori colonization and gastritis incidence, severity and, especially, activity of the antrum might all contribute to mucosal erosion and ulceration, whereas the same factors, at least in part and with the exception of proximal GU, seem to have a preventive role when affecting corpus mucosa.

Effects of amoxicillin-clavulanate combination on the motility of the small intestine in human beings

The amoxicillin-clavulanate combination (Augmentin) frequently induces gastric complaints and diarrhea by an unknown mechanism. The aim of this study was to assess the effects of two orally therapeutic regimens of amoxicillin-clavulanate on small bowel motility in human beings. Duodeno-jejunal manometric recordings were performed in six healthy subjects treated in a cross-over double-blind study with placebo; amoxicillin-clavulanate, 1 g plus 250 mg per os every 12 h for 3 days; or amoxicillin-clavulanate, 1 g plus 250 mg per os every 12 h on day 3 only (1-day regimen). Recordings were all performed on day 3 during a diurnal fasting period, a fed state after a standard dinner, and a nocturnal fasting period. Amoxicillin-clavulanate did not affect the motility of the small intestine during the diurnal fast or the fed state. During the nocturnal fast, amoxicillin-clavulanate significantly increased the motility index of the nonpropagated contractions and tended to increase the duration and the amplitude of the propagated contractions. The same digestive motor effect was already observed on the first day of treatment (1-day regimen). This study demonstrates that the oral administration of a therapeutic regimen of amoxicillin-clavulanate is associated, in most cases, with the occurrence of small intestinal motor disturbances.

Gastric emptying after gastric interposition for cancer of the esophagus or hypopharynx

Transhiatal esophagectomy with primary anastomosis to the stomach (gastric pull-up) is an attractive surgical alternative to colic interposition in patients with cancer of the esophagus and hypopharynx. However, the lack of intrinsic gastric peristalsis and complaints by patients ol postprandial regurgitation prompted us to measure the effect of body posture on the rates of gastric emptying in these patients. The rates of solid and liquid gastric emptying were measured in 14 patients who had undergone gastric interposition for esophageal and hypopharyngeal carcinoma. Rates of emptying were measured in both the supine and upright position using a dualisotope radiolabeling technique. In these patients, the rate of gastric emptying of both solids and liquids was significantly slower in the supine position than in the upright position. Emptying in supine patients was also prolonged when compared with supine normal volunteers. Conversely, the upright rate of solid and liquid emptying in the patients was accelerated when compared with published values for upright normal volunteers. We conclude that gastric emptying after gastric interposition is dependent on upright posture after meals.

Evaluation of an immunofluorescence assay for specific detection of immunoglobulin G antibodies directed against Helicobacter pylori, and antigenic cross-reactivity between H. pylori and Campylobacter jejuni

An immunofluorescence assay (IFA) for the detection of immunoglobulin G antibodies directed against Helicobacter pylori was evaluated by comparing 20 serum specimens from patients with a positive urease test on biopsy material and 20 serum specimens from patients with a negative test and with defined clinical symptoms. The resulting anti-H. pylori titers were classified as follows: negative, less than or equal to 64; borderline, 128; and positive, greater than or equal to 256. By using these criteria, the IFA was subsequently tested, using 100 serum specimens from patients with gastric complaints. Overall, the titers were 71% positive, 10% borderline, and 19% negative. Depending on the patients' biopsy urease test results, the sensitivity and specificity of the assay were calculated to be 96%. Furthermore, these sera were classified into three subgroups on the basis of clinical manifestations: gastritis with 74% positive and 10% borderline titers, duodenal ulcer with 84% positive and 4% borderline titers, and gastric ulcer with 52% positive and 16% borderline titers. A serologic follow-up study was carried out with three patients with gastric ulcers who had been treated with colloidal bismuth subcitrate for 4 weeks and erythromycin for the final 2 weeks. The results indicate that a significant decrease in titer could be expected within 9 to 12 months after successful therapy, as determined by repeated negative CLO tests. Absorption experiments demonstrated that possible cross-reactivity between H. pylori and C. jejuni did not influence serodiagnosis.

A behaviorally oriented stress reduction program and its effects upon self‐reported gastric complaints

AbstractThe response of common but disturbing gastric complaints to psychological intervention has not been studied despite evidence that clinical levels of gastrointestinal disorders respond to treatment. The present study examines the effect of a behaviorally oriented stress reduction program on such self‐reported gastrointestinal complaints among a group of 179 subjects. Pre‐and post‐treatment measures were obtained on the frequency of indigestion, nausea, ulcer attacks, colitis, diarrhea, and constipation complaints. Significant decreases were found from pre to post indigestion, nausea, colitis, diarrhea, and constipation and significant decreases were maintained at follow‐up for indigestion, nausea and constipation complaints. These results suggest that relief from common gastric complaints may be obtained from a behaviorally oriented treatment program, and that such a program may also affect the potential development of maladaptive learned gastric response habits.

Use of spectral analysis in the detection of frequency differences in the electrogastrograms of normal and diabetic subjects.

The authors investigated the basal electrical rhythm (BER) of the stomach to determine if abnormalities of the BER occur in association with those gastric complaints in patients with long-term insulin-dependent diabetes. They recorded the basal electrical signal of the stomach in nine patients with diabetic gastroparesis and in 11 normal volunteers. They developed a microcomputer-based running spectral analysis technique (overlapping fast Fourier transforms) to analyze the recordings. They found no significant differences between the two subject groups in the prefed state but found a significantly higher proportion of episodes of high frequency, or tachygastria in the diabetic group in the postfed state (15.4-6.2%). The difference was also reflected in the higher postfed mean 'peak' frequency of the diabetics. Both diabetics and normals show an increase in the mean of the peak frequency from pre- to postfed states, but the normals do not show an increase in episodes of tachygastria. >

Radioisotope Evidence of Varying Transit of Solid Food in Gastrectomized Patients with and without Dumping Syndrome

Of 29 Billroth II gastrojejunostomy patients studied by scintigraphy, 11 were dumpers and 18 were non-dumpers; of 20 controls, 11 were patients with different gastric complaints and 9 volunteers with no history of gastrointestinal pathology. The tracer used was human albumin microspheres labelled with 99mTc, mixed thoroughly with a fresh scrambled egg, cooked as an omelet and eaten as a sandwich with white toasted bread. The transit and emptying of the radiolabelled meal in the gastric and derivative loop areas were followed with gamma camera 90-120 min. In the dumpers half-emptying times were significantly shorter than in the controls; in the non-dumpers they were even shorter. Dynamic selective analysis of the radiolabelled food transit through derivative afferent and efferent loops showed, on the other hand, different patterns for the two groups of gastroresected patients: the progression of propulsive waves was very irregular and constantly hyperperistaltic only in the dumpers.

Isolation of Campylobacter pyloridis from human gastric mucosa and characterization of the isolates.

Biopsy specimens of human gastric mucosa of patients with gastric complaints and subjected to endoscopic examination were cultured microaerobically, and Campylobacter pyloridis was detected in 46 out of 80 cases (57.5%). The organism was found in 13 out of 22 patients with gastritis, 11 out of 16 with gastric ulcer scar, 7 out of 16 with gastric ulcer, 3 out of 9 with gastric polyp, 4 out of 5 with gastric carcinoma, 2 out of 2 with esophagus carcinoma, and 6 out of 9 with other gastric diseases. The isolates were identified as C. pyloridis, demonstrating its characteristic features such as positive for oxidase and catalase, negative for reduction of nitrite and nitrate, positive for urease, no growth at 25 C, growth at 37 C, not tolerant to 1% glycine, and resistant to nalidixic acid. Positive alkaline phosphatase activity was considered as an additional feature characteristic for the strains of C. pyloridis. The major cellular fatty acids were tetradecanoic acid and 19-carbon-cyclopropane acid. This pattern is unique among Campylobacter species. The survival of the organism for a longer period than 60 min at pH 2.5 indicates its significant resistance to acidic environment.

Treatment of chronic osteomyelitis with ciprofloxacin

The results of the treatment of twenty-one patients (age 22-66 years) with chronic bone or joint infections with ciprofloxacin were evaluated. The osteomyelitis was secondary to trauma in 12 patients, joint replacement in six, previous acute hematogenous infection in two and osteotomy in one. Stafylococcus aureus (11 times) and Pseudomonas aeruginosa (9 times) were most frequently cultured. The duration of ciprofloxacin therapy averaged 76 days. Concomitant antimicrobial drugs were used in one patient only. Fifteen patients were operated during treatment; in most cases the surgical procedure consisted of a thorough debridement. Nineteen patients could be evaluated. The bacteriological results were as follows: eradication 27; marked reduction 1; eradication with recurrence 1. Contamination occurred in five patients and superinfection in two, without much influence on the final outcome. The investigator's assessment at the end of the therapy was as follows: complete success in 14 patients and partial success in seven. During the follow-up (3-13 months) the therapy was judged completely successful in 16, partially successful in four and unsuccessful in one. Two patients had minor gastric complaints during therapy and one showed a temporary slight increase in the liver transaminases.

Isolation of Campylobacter pyloridis from gastric mucosa of patients with gastric complaints and susceptibility of the isolates on antibiotics

Campylobacter pyloridis strains were isolated from biopsy specimens referred for three loci (antrum, lower body of lesser curvature, and/or upper body of greater curvature) in the stomach, and/or from the gastric juice of 46 out of various specimens of 91 patients withgastric complaints. This organism was found in gastric mucosa of 3 out of 7 cases and gastric juice of 2 outof 20 cases. Out of gastric mucosa and juice of 47 cases, the organism was isolated from gastric mucosa of 28cases and from both specimens of 11 cases. Furthermore, C. pyloridis was positive for gastricmucosa of one case out of gastric mucosa, gastric juice and saliva of 3 cases, and for it out ofgastric mucosa, gastric juice and bile of one case. But no C. pyloridis strain was found in gastric juice and duodenal fluid of2 cases, duodenal and jejunal fluid of one case, bile of one case, jejunal fluid of3cases, intestinal mucosa of 4 cases, gingival mucosa of one case and saliva of one case. Positive rates of C. pyloridis from gastric mucosa and gastric juice were 44/58 cases (108/153 biopsy specimens) and 13/73 cases, respectively. It is noteworthy that the organism could be very frequently cultivated from the gastric juice whosepH was 2 or 3. Susceptibility of the isolates of C. pyloridis from46 positive cases against 18 antibiotics was studied. All isolates were sensitiveagainst Penicillins, Cephalosporins, Aminoglycosides, Tetracycline and Chloramphenicol and resistant against Nalidixic acid, Colistin and Bacitracin. But the strains were clearly divided into two groups, the sensitive (44 strains) and the resistant (2 strains) to Macrolides.

乳牛の各種胃腸疾患と徐脈の関係

乳牛の各種胃腸疾患と徐脈の関係

Acemetacin in the treatment of rheumatic diseases: an open, multi-centre trial

An open, multi-centre trial was carried out to assess the efficacy and tolerance of acemetacin in the treatment of patients suffering from various rheumatic diseases. The patients were treated by general practitioners for a maximum period of 6 weeks with a daily dose of 60 mg acemetacin 3-times daily. Assessments were made before, during and after treatment of pain parameters, joint function and swelling, and records kept of any adverse events reported. At the end of treatment, the physician made an overall assessment of response. Data from 760 patients were analyzed and showed 'very good' or 'good' improvement in 55% and 28.5% of patients, respectively. A relatively low percentage (16.3%) reported adverse events, which may or may not have been drug related, and there were few reports (10.7%) of gastric complaints. Twenty-seven (3.6%) patients withdrew from the study for reasons not specified.

Epidemiology of Gastric Cancer in Chile. III. Diagnostic Practices in Santiago, 1976–8

The purpose of this paper is to estimate the validity of current diagnostic procedures used in Santiago, Chile, in identifying gastric cancer (GC) patients among people with gastric complaints, many of whom suffer possible premalignant conditions. Review of diagnoses on 2296 patients seen at the University Hospital during 1976 and 1977 revealed 103 confirmed cases of adenocarcinoma. This review permitted us to estimate the validity of clinical/radiological and endoscopic methods versus diagnosis made from pathological specimens. A code of diagnostic categories was generated for application in eight hospitals participating in a subsequent case-control study of GC. A high prevalence of chronic atrophic gastritic (CAG) and chronic gastric ulcer (CGU) was found, both conditions together accounting for 50% of diagnoses on 845 clinic controls during the study period 1977-8. The value of gastroscopy and biopsy to separate out GC from other gastric conditions, the importance of studying the epidemiology of premalignant conditions in Chile, and differences between GC in Chile and the United States are discussed.

Alterations of surface electrocardiogram in 35 patients during upper fiberendoscopy.

Thirty-five patients with gastric complaints were analysed by continuous cardiac monitoring during routine upper fiberendoscopy (UFE); 15 of them showed previous electrocardiographic alterations. New alterations occurred in 8 patients during fiberendoscopy, all of them with previous changes of the electrocardiographic pattern: all these were slight and transient. Atrial and ventricular premature beats (more frequent and persistent in women), complete bundle branch block, atrial fibrillation, and ischemic T wave were detected, the latter in only one male patient. Generally the ECG alterations appear when the fiberscope passed the medium third of the esophagus and the cardia. The changes observed on withdrawal of the optic apparatus were irrelevant. Tachycardia was, as a rule, more frequent and persistent in women. Candidates to UFE shouid be previousiy submitted, at ieast, to screening standard ECG.

Cancer of the stomach

Carcinoma of the stomach, although its incidence is decreasing in the United States, is still a fatal disease. The results today are actually no better than they were 30 years ago because we are still making late diagnoses. In order to improve our results in the treatment of cancer of the stomach, we must perform fiberoptic gastroscopy in individuals over age 40 who have gastric complaints that do not respond readily to conservative medical therapy. At the time of endoscopy, multiple biopsies of gastric mucosa must be taken. Only in this way can early enough diagnoses be made to increase the survival rate in gastric carcinoma.