Serum Pepsinogen Concentrations Research Articles

A DSC Test for the Early Detection of Neoplastic Gastric Lesions in a Medium-Risk Gastric Cancer Area.

In this study, we aimed to assess the accuracy of the proposed novel, noninvasive serum DSC test in predicting the risk of gastric cancer before the use of upper endoscopy. To validate the DSC test, we enrolled two series of individuals living in Veneto and Friuli-Venezia Giulia, Italy (n = 53 and n = 113, respectively), who were referred for an endoscopy. The classification used for the DSC test to predict gastric cancer risk combines the coefficient of the patient's age and sex and serum pepsinogen I and II, gastrin 17, and anti-Helicobacter pylori immunoglobulin G concentrations in two equations: Y1 and Y2. The coefficient of variables and the Y1 and Y2 cutoff points (>0.385 and >0.294, respectively) were extrapolated using regression analysis and an ROC curve analysis of two retrospective datasets (300 cases for the Y1 equation and 200 cases for the Y2 equation). The first dataset included individuals with autoimmune atrophic gastritis and first-degree relatives with gastric cancer; the second dataset included blood donors. Demographic data were collected; serum pepsinogen, gastrin G17, and anti-Helicobacter pylori IgG concentrations were assayed using an automatic Maglumi system. Gastroscopies were performed by gastroenterologists using an Olympus video endoscope with detailed photographic documentation during examinations. Biopsies were taken at five standardized mucosa sites and were assessed by a pathologist for diagnosis. The accuracy of the DSC test in predicting neoplastic gastric lesions was estimated to be 74.657% (65%CI; 67.333% to 81.079%). The DSC test was found to be a useful, noninvasive, and simple approach to predicting gastric cancer risk in a population with a medium risk of developing gastric cancer.

Evaluation of serum pepsinogen concentration for the diagnosis of type 1 abomasal ulcer in water buffalo

Evaluation of serum pepsinogen concentration for the diagnosis of type 1 abomasal ulcer in water buffalo

Evaluation of the Potential Protective Effects of Lactobacillus Strains against Helicobacter pylori Infection: A Randomized, Double-Blinded, Placebo-Controlled Trial.

Background The beneficial effects of probiotic supplementation standard antibiotic therapies for Helicobacter pylori infection have been verified, but the ability of probiotic monotherapy to eradicate H. pylori remains unclear. Aim To evaluate the accuracy and efficacy of specific Lactobacillus strains against H. pylori infection. Methods Seventy-eight patients with H. pylori infection were treated with strain L. crispatus G14-5M (L. crispatus CCFM1118) or L. helveticus M2-09-R02-S146 (L. helveticus CCFM1121) or L. plantarum CCFM8610 at a dose of 2 g twice daily for one month. 14C-urea breath test, the gastrointestinal symptom rating scale, serum pepsinogen concentrations, and serum cytokine concentrations of patients were measured at baseline and end-of-trial to analyze the effect of the Lactobacillus strains in eradicating H. pylori infection and reducing gastrointestinal discomfort in patients. In addition, the composition and abundance of the intestinal microbiota of patients were also measured at end-of-trial. Results The 14C-urea breath test value of the three Lactobacillus treatment groups had decreased significantly, and the eradication rate of H. pylori had increased by the end of the trial. In particular, the eradication rate in the G14-5M treatment group was significantly higher than the placebo group (70.59% vs. 15.38%, P=0.0039), indicating that one-month administration of the G14-5M regimen was sufficient to eradicate H. pylori infection. The ingestion of Lactobacillus strains also ameliorated the gastrointestinal symptom rating scale scores, and the serum interleukin-8 concentrations of H. pylori-infected patients appeared to modulate the gut microbiota of patients. However, none of the Lactobacillus strains had a significant effect on general blood physiological characteristics, serum tumor necrosis factor α concentrations, or serum pepsinogen concentrations in the patients. Conclusion Three Lactobacillus strains significantly alleviate the gastrointestinal discomfort and the gastric inflammatory response of H. pylori-infected patients. The activity of probiotics in eradicating H. pyloriinfection may be species/strain specific.

Helicobacter pylori infection and serum pepsinogen concentrations in an elderly population representative of Costa Rica

INTRODUCTION: Costa Rica has among the highest mortality rates from gastric cancer in the world, largely due to late detection. It is therefore important that economically and logistically sustainable screening is implemented in order to detect risk of developing cancer. We have previously shown that low pepsinogen (PG) values and infection with Helicobacter pylori-CagA+ are associated with risk of gastric atrophy and cancer in Costa Rican populations. OBJECTIVES: To determine how markers for gastric cancer risk are distributed in an elderly population representative of Costa Rica in order to design a screening strategy. METHODS: The population studied consists of 2,652 participants in a nationally representative survey of ageing. Information concerning epidemiologic, demographic, nutritional and life style factors is available. Serum PG concentrations as well as H. pylori and CagA status were determined by serology. Possible associations were determined by regression analyses. RESULTS: Antibodies to H. pylori were present in 72% of the population and of those, 58% were CagA positive. Infection with H. pylori was associated with higher PGI concentrations (p=0.000) and infection with H. pylori-CagA+ with lower PGI concentrations (p=0.025). Both showed association with lower PGI/PGII (p=0.006 and p=0.000). Higher age was associated with lower prevalence of H. pylori infection (OR=0.98; p=0.000) and CagA+ (OR=0.98; p=0.000) but not with PG values. Regions with high risk of gastric cancer showed lower PGI (p=0.004) and PGI/PGII values (p=0.021) as well as higher prevalence of H. pylori infection (OR=1.39; p=0.013) but not CagA+. Using cut-off values of PGI<100 µg/L and PGI/PGII<2.0, 2.5 and 3.0, 7-15% of the population would be considered at risk. CONCLUSIONS: H. pylori alone is not a useful marker for risk of gastric cancer. Screening using serum pepsinogen concentrations and infection with H. pylori-CagA+ is feasible in the general elderly population of Costa Rica but appropriate cut-off values have to be determined based on more clinical data and follow up capacity.

Helicobacter pylori infection and serum pepsinogen concentrations in an elderly population representative of Costa Rica

Helicobacter pylori infection and serum pepsinogen concentrations in an elderly population representative of Costa Rica

Subclinical nematode parasitism affects activity and rumination patterns in first-season grazing cattle

Sickness behaviour has been suggested as an applicable indicator for monitoring disease. Deviating feeding behaviour and activity can provide information about animals’ health and welfare status. Recent advances in sensor technology enable monitoring of such behaviours and could potentially be utilized as an indicator of gastrointestinal nematode (GIN) infections. This study investigated activity and rumination patterns in first-season grazing steers exposed to subclinical infection levels of the GIN Ostertagia ostertagi and Cooperia oncophora. At turnout, animals were allocated to one of four experimental groups and were faced with “high” (H1, n = 15; H2, n = 17) or “low” (L1, n = 17; L2, n = 11) levels of parasite exposure by grazing in similar enclosures contaminated with overwintering third stage (L3) GIN larvae. Animals in H1 and H2 (HP) received a 1:1 mix of approximately 10,000 O. ostertagi and C. oncophora L3 at turnout; whereas the animals in L1 and L2 (LP) were treated monthly with ivermectin. Activity and rumination patterns were monitored by fitting animals with leg- (IceQube) and neck-mounted (Heatime) sensors. BW was recorded every fortnight, whereas faecal and blood samples were examined every four weeks for nematode faecal egg count and serum pepsinogen concentrations (SPCs). There was an interaction effect of exposure level and period (P < 0.0001) on average lying daily time across the entire grazing time. A higher mean daily lying time (P = 0.0037) was found in HP compared with LP during the first 40 days on pasture. There was also interaction effects of treatment and day since turnout on rumination time (P < 0.0001) and rumination change (P = 0.0008). Also mean daily steps (P < 0.0001) and mean daily motion index (P < 0.0001) were markedly higher in HP during days 62–69, coinciding with peaking SPC in HP. Strongyle eggs were observed both in HP and LP from 31 days after turnout. Eggs per gram (EPG) differed between parasite exposure levels (P < 0.0001), with mean EPG remaining low in LP throughout the experiment. Similarly, an increase in SPC was observed (P < 0.0001), but only in HP where it peaked at day 56. In contrast, no difference in BW gain (BWG) (P = 0.78) between HP and LP was observed. In conclusion, this study shows that behavioural measurements monitored with sensors were affected even at low infection levels not affecting BWG. These combined results demonstrate the potential of automated behavioural recordings as a tool for detection of subclinical parasitism.

Serum pepsinogen and gastrin concentrations in South American camelids with and without gastrointestinal nematode infection

Abstract Endoparasitosis is one of the major health problems in South American camelids (SACs) often leading to massive damage of the gastric or intestinal mucosa. In ruminants this damage results in increased gastrin and pepsinogen concentrations in the peripheral blood. These values have been used as diagnostic parameters for subclinical gastrointestinal nematode infections in ruminants but have not been systemically studied in SACs. Serum pepsinogen and gastrin concentrations of 183 clinically healthy SACs with and without detectable parasitic egg excretion and the occurrence of occult blood in the faeces were determined. The median (1st/3rd quartile) of serum pepsinogen and gastrin were 1899.4 (1483.1/2749.4) ng/ml and 184.8 (121.8/340.5) pg/ml for alpacas; 1642.0 (1182.3/2608.7) ng/ml and 191.8 (142.2/287.6) pg/ml for llamas respectively. A sensitivity of 80.1 % and a specificity of 11.1 % for gastrin (cut off 402 pg/ml) and a sensitivity of 64.1 % and specificity of 88.9 % for pepsinogen with endoparasitosis (cut off 1996 ng/ml) were calculated. Based on our results, albeit on quite small numbers, determination of serum gastrin concentration does not seem to be a useful test for the detection of endoparasitic infection in SACs. In contrast, for pepsinogen a correlation was found between serum concentration and animals with and without endoparasitosis. Nevertheless further studies are necessary in order to investigate the diagnostic potential of pepsinogen serum concentration in relation to subclinical endoparasitosis.

Effects of nematode parasitism on activity patterns in first-season grazing cattle

We investigated the effects of gastrointestinal nematode (GIN) challenge on activity patterns in first season grazing (FSG) steers exposed to two different levels of Ostertagia ostertagi and Cooperia oncophora. At turn-out, experimental animals were allocated to one of two treatment groups grazing in different enclosures each with 32 animals. The first group (High) received 5000 third stage (L3) O. ostertagi (50%) and C. onchophora (50%) larvae; whereas the second group (Low) were dewormed monthly with 0.5 mg ivermectin (Noromectin®, Pour-on) per kg bodyweight. Activity patterns were monitored by fitting some animals in each group (High, n = 10; Low, n = 8) with leg mounted sensors (IceTag® 3D-accelerometers) during three two-week periods. In animals fitted with sensors body weight gain (BWG) was recorded every fortnight, whereas faecal and blood samples were collected every four weeks for nematode faecal egg count (FEC) and serum pepsinogen concentrations (SPC). Differences between the periods in daily (P = 0.046) and diurnal (P = 0.0502) activities were recorded between groups during the course of the study. A significant (P = 0.038) increase in the number of lying bouts was recorded in group High during the second period (days 74–86), which was correlated (r = 0.55, P = 0.018) to an increase in SPC ≈ 85 days after turn-out. BWG was reduced (P = 0.037) in group High compared to group Low, deviating from day 45. Strongyle nematode eggs were observed in both groups 29 days after turn-out, however the mean EPG remained low in group Low throughout the experiment. An increase in SPC was observed (P < 0.0038) in group High with levels peaking on day 58. In conclusion, our data supports that changes in activity patterns monitored with sensors could contribute to the identification of animals challenged with GIN, but also improve our understanding in the potential welfare impairments caused by such infections.

Gastric Cancer Screening by Combined Determination of Serum Helicobacter pylori Antibody and Pepsinogen Concentrations: ABC Method for Gastric Cancer Screening.

Objective:Gastroscopy combined with gastric mucosa biopsies is currently regarded as a gold standard for diagnosis of gastric cancer. However, its application is restricted in clinical practice due to its invasive property. A new noninvasive population screening process combining the assay of anti-Helicobacter pylori antibody and serum pepsinogen (PG) (ABC method) is adopted to recognize the high-risk patients for further endoscopy examination, avoiding the unnecessary gastroscopy for most population and saving the cost consumption for mass screening annually. Nevertheless, controversies exist for the grouping of ABC method and the intervals of gastroscopy surveillance for each group. In this review, we summarized these popular concerned topics for providing useful references to the healthcare practitioner in clinical practice.Data Sources:The PubMed databases were systematically searched from the inception dates to November 22, 2017, using the keywords “Helicobacter pylori,” “Pepsinogens,” and “Stomach Neoplasms.”Study Selection:Original articles and reviews on the topics were selected.Results:Anti-H. pylori antibody and serum PG concentration showed significant changes under the different status of H. pylori infection and the progression of atrophic gastritis, which can be used for risk stratification of gastric cancer in clinic. In addition, anti-H. pylori antibody titer can be used for further risk stratification of gastric cancer contributing to determine better endoscopy surveillance interval.Conclusions:The early detection and diagnosis of gastric cancer benefit from the risk stratification, but the cutoff values for H. pylori antibody and serum PG concentration require further modification.

Weight gain and resistance to gastrointestinal nematode infections in two genetically diverse groups of cattle

Body weight gain (BWG) and gastrointestinal nematode challenge (GIN) were investigated in two genetically diverse groups of cattle. Thirty-two dairy calves (D = Swedish Red/Holstein) and 31 dairy × beef crosses (C = Swedish Red/Holstein × Charolais) pairwise matched by dam breed and birth dates, were monitored for ≈20 weeks on a pasture grazed by cattle in the previous year. At turn-out, animals (between 6 and 12 months age) from each genotype were either infected with 5000 third stage (L3) Ostertagia ostertagi (50%) and Cooperia oncophora (50%) larvae (H, high-exposure); or treated monthly with 0.5 mg ivermectin (Noromectin®, Pour-on) per kg bodyweight to remove worms ingested (L, low-exposure). Animals were weighed every fortnight and individual BWG was calculated. Faecal and blood samples were collected every four weeks throughout the experiment for nematode faecal egg counts (FEC) and larvae cultures and serum pepsinogen concentrations (SPC), respectively. Nematode eggs were observed 29 days post turn-out in both H groups. FEC peaked to around 200 eggs per gram (epg) on days 58 and 85 respectively in both H groups. FEC were also observed in the L groups at the same time, but mean epg remained very low (<20 epg) and constituted exclusively of C. oncophora. Although, there was no significant difference in SPC values in animals of the different genotypes, ten animals of CH showed a SPC >3.5 IU tyrosine whereas only six DH animals reached similar pepsinogen levels. The level of infection (H and L) significantly affected BWG in both genotypes. Even though there was no statistically significant genotype (C or D) × treatment (H or L) interaction, there was a larger difference in body weight of H and L in C (37 kg) compared to D (17 kg) genotypes at the end of the experiment. Our data collectively support the view crossbred (C) animals experience the impact of gastrointestinal parasitism more severely compared to pure dairy (D) first season grazers. The mechanisms that underpin this remains speculative.

Cost-effectiveness of combined serum anti-Helicobacter pylori IgG antibody and serum pepsinogen concentrations for screening for gastric cancer risk in Japan.

A combination of assays for the presence of serum anti-Helicobacter pylori IgG antibody (HPA) and serum pepsinogen (PG) concentrations can be used to screen for gastric cancer risk. In Japan, this "ABC method" is considered an effective means of stratifying gastric cancer risk. This study aimed to ascertain its cost-effectiveness for assessing gastric cancer risk. A Markov model was constructed to compare the cost-effectiveness of two strategies for gastric cancer-risk screening over a 30-year period: the ABC method, which uses a combination of assessing the presence of HPA and measuring serum PG concentrations and scheduling endoscopies accordingly, and annual endoscopic screening. Clinical and epidemiological data on variables in the model were obtained from published reports. Analyses were made from the perspective of the Japanese health care payer. According to base-case analysis, the ABC method cost less than annual endoscopic screening (64,489 vs. 64,074 USD) and saved more lives (18.16 vs. 18.30 quality-adjusted life years). One-way analyses confirmed the robustness of the cost-effectiveness results. The probability that the ABC method is cost-effective in Japanese individuals aged 50years was 0.997. A combination of HPA and serum PG assays, plus scheduling endoscopy accordingly, is a cost-effective method of screening for gastric cancer risk in Japan.

The Serum Pepsinogen Test as a Predictor of Kazakh Gastric Cancer

Gastric cancer (GC) is one of the most common malignant tumors and the Kazakh population in Xinjiang has been reported to be one of the highest incidence of GC in the world. Serum pepsinogen (PG) test provides a valuable method for detecting GC, but little study about the role of PG in Kazakh GC. Therefore, we aimed to investigate the role of PG in Kazakh GC and to elucidate the usefulness of the serum PG test method. The serum PG concentration were measured using the flow fluorescence assay and ELISA methods in patients with superficial gastritis, atrophic gastritis and GC. The most suitable cut off point was a PG I concentration ≤64 ng/ml and PG I/II ratio (PGR) ≤4.5. Using this cut off point, the sensitivity and specificity of pepsinogen screening for Kazakh GC were 80.5% and 89.8%, respectively. The area under the curve (AUC) of the PGR for GC diagnosis was 0.949, which was significantly higher than that of combined tumor markers. Moreover, PGR in Kazakh early GC was statistically significantly lower than in SG and AG. These findings suggest that serum PG test can serve as a noninvasive biomarker for the diagnosis of Kazakh GC.

Can the amount of digestible undegraded protein offered to ewes in late pregnancy affect the periparturient change in resistance to gastrointestinal nematodes?

Ewes experience a temporary decline in resistance to gastrointestinal nematodes (GIN) during the periparturient period, characterised by a rise in faecal egg count (FEC) that represents a major source of pasture contamination for naïve progeny. The aim of this study was to assess the effect of level of supplementation with digestible undegraded protein (DUP) during the last 6 weeks of pregnancy on periparturient FEC and the performance of ewes with a naturally acquired parasite infection. Eighty-five Belclare and Belclare x Scottish Blackface twin/triplet-bearing ewes were allocated to 1 of 4 dietary groups representing the combination of 2 concentrates (DUP concentration 29 and 94g/kg dry matter) with 2 levels of concentrate during the final 6 weeks of gestation (18 and 30kg in total for ewes with twins; 24 and 35kg for ewes with triplets). All ewes were housed during the pre-partum feeding period and offered grass silage ad libitum; food intake was recorded daily. The intake of DUP varied from 26 to 72g/d among treatments and was reflected in variation of 0.76 to 1.20 in metabolizable protein supply as a proportion of requirements. After lambing, ewes and lambs grazed on permanent sheep pasture, without concentrate supplementation, until weaning (14 weeks post lambing). The variables studied, from week 6 pre-lambing up to week 10 post-lambing, included: FEC, serum pepsinogen concentration, body weight (BW) and body condition score (BCS). The effect of week (relative to lambing date) on FEC was highly significant (P<0.001). However, diet did not influence FEC (P>0.05) at any stage either pre- or post-partum. Pepsinogen concentration also varied with time but was not influenced by dietary treatment (P>0.05). The changes in BW and BCS from 6 weeks before lambing to weaning were not affected by the concentration of DUP in the supplement but ewes on treatments involving the higher level of supplementation lost less BW and BCS (P<0.001). The results of this study indicate that the level of DUP supplementation during the last 6 weeks of pregnancy does not affect FEC, BW or BCS of housed ewes with a naturally acquired GIN infection.

Anthelmintic resistance in ruminants: development, diagnostics, and procedures

Anthelmintic resistance of gastrointestinal nematodes in small ruminants, but also in cattle and horses, is now found worldwide. The reason for increasing anthelmintic resistance is, in particular, the extensive use of all the anthelmintic agents available on the market. A non-targeted use leads to the selection of naturally occurring resistance genes within parasite populations. The most practical method for evaluating the efficacy of an anthelmintic is the fecal egg-count reduction test. To reduce the rate of anthelmintic resistance development, the available active substances must be applied less and in a targeted manner. When applying targeted (selective) treatment, part of the herd is left untreated. Therefore, it is necessary to identify the animals that require treatment for health or economic reasons. To decide on anthelmintic treatment, findings can be collected from single animals or from a group of animals in a herd. To determine which groups of animals are to be treated within a herd (targeted treatment), pooled fecal samples (cattle and small ruminants), serum pepsinogen concentration (cattle), or Ostertagia ostertagi antibodies in the bulk milk (cattle) can be analyzed. For individual animal (targeted selective) treatment, criteria including fecal egg count (cattle and small ruminants), conjuctival color as an indicator for infection with Haemonchus contortus (FAMACHA®, small ruminants), body condition in adult animals (small ruminants), weight gain in juvenile animals (cattle and small ruminants), and the consistency of the feces (small ruminants) are used. These decision criteria can also be combined to enhance the informative value. Furthermore, an efficacy test of the anthelmintics used should be performed regularly at the beginning of the pasture season. During the pasture season, a low infection pressure should be maintained by pasture management strategies. The goal of sustainable parasite management is the reduction of anthelmintic treatment while maintaining the productivity and health of the animals and thus a longer effectiveness of the available drugs.

Link between Serum Pepsinogen Concentrations and Upper Gastrointestinal Endoscopic Findings.

The serum pepsinogen (PG) assay findings are correlated with the status of Helicobacter pylori infection, but there are controversies on the link with upper gastrointestinal (UGI) endoscopic findings. The aim of this study was to determine the significance of a serum PG assay for correlating with endoscopic findings in H. pylori-seroprevalent adult population. Korean adults who visited for a health check-up were included consecutively. Subjects after gastrectomy or H. pylori eradication were excluded. After completing the serum PG assay and anti-H. pylori immunoglobulin G (IgG) titer on the same day of UGI endoscopy, subjects with equivocal serology test finding or gastric neoplasm were excluded. Of the 4,830 included subjects, 3,116 (64.5%) were seropositive for H. pylori. Seropositive finding was related to high serum PG I (P < 0.001) and PG II (P < 0.001) concentrations, low PG I/II ratio (P < 0.001), old age (P < 0.001), and male gender (P = 0.006). After adjusting age and gender, the serum PG I and II concentrations were positively correlated with the presence of nodular gastritis (NG) (all P = 0.003). The serum PG I was positively correlated with gastric ulcer (P = 0.003), and it was correlated with duodenal ulcer in seropositive subjects (P = 0.008). The PG I/II ratio was positively correlated with erosive esophagitis, while it was inversely related to chronic atrophic gastritis and metaplastic gastritis (all P < 0.001). Our findings suggest that the serum PG assay finding correlates well with the UGI endoscopic finding. A higher serum PG concentration in subjects with NG and peptic ulcer disease suggests that endoscopic findings reflect gastric secreting ability.

Serum Pepsinogen Levels Are Correlated With Age, Sex and the Level of Helicobacter pylori Infection in Healthy Individuals

BackgroundTo explore the relationship between age, sex, the level of Helicobacter pylori (HP) infection and serum pepsinogen (PG) in healthy people undergoing a medical examination. MethodsA total of 6,596 “healthy” individuals undergoing a medical examination were selected as subjects in this study. The concentrations of serum pepsinogen I (PGI) and serum pepsinogen II (PGII) were tested for each of the subjects using time-resolved fluorescence immunoassay characterized with high sensitivity and wide measuring range. The infection ratio and level of HP were tested using a 13C-urea breath test to analyze the relationship between age, sex, HP infection, and serum PGs. ResultsThe PGI, PGII and PGI-to-PGII ratio (x¯±S) were higher in males than in females. The serum PGI and PGII levels gradually increased with age. HP infection rate was 48.83%, and the serum PGI, PGII and PGI-to-PGII ratio (x¯±S) were 187.05 ± 73.50µg/L, 18.09 ± 8.68µg/L and 11.67 ± 5.44, respectively in the HP-positive group and 150.39 ± 67.04µg/L, 11.50 ± 7.45µg/L and 15.67 ± 8.19, respectively in the HP-negative group. There was significant difference in the detection rate of an abnormal PG between the 2 groups as with the worsening of HP infection, 13C-urea breath test and serum PGI and PGII levels increased, but the PGI-to-PGII ratio decreased significantly. ConclusionsSerum PGI and PGII levels were correlated with age, sex and the level of HP infection. Therefore, the influencing factors of age, sex and the level of HP infection should be considered when screening stomach diseases using PG.

Does the antibody production ability affect the serum anti-Helicobacter pylori IgG titer?

To investigate the relationship between serum titers of anti-Helicobacter pylori (H. pylori) immunoglobulin G (IgG) and hepatitis B virus surface antibody (HBsAb). Korean adults were included whose samples had positive Giemsa staining on endoscopic biopsy and were studied in the hepatitis B virus surface antigen (HBsAg)/HBsAb serologic assay, pepsinogen (PG) assay, and H. pylori serologic test on the same day. Subjects were excluded if they were positive for HBsAg, had a recent history of medication, or had other medical condition(s). We analyzed the effects of the following factors on serum titers of HBsAb and the anti-H. pylori IgG: Age, density of H. pylori infiltration in biopsy samples, serum concentrations of PG I and PG II, PG I/II ratio, and white blood cell count. Of 111 included subjects, 74 (66.7%) exhibited a positive HBsAb finding. The serum anti-H. pylori IgG titer did not correlate with the serum HBsAb titer (P = 0.185); however, it correlated with the degree of H. pylori infiltration on gastric biopsy (P < 0.001) and serum PG II concentration (P = 0.042). According to the density of H. pylori infiltration on gastric biopsy, subjects could be subdivided into those with a marked (median: 3.95, range 0.82-4.00) (P = 0.458), moderate (median: 3.37, range 1.86-4.00), and mild H. pylori infiltrations (median: 2.39, range 0.36-4.00) (P < 0.001). Subjects with a marked H. pylori infiltration on gastric biopsy had the highest serological titer, whereas in subjects with moderate and mild H. pylori infiltrations titers were correspondingly lower (P < 0.001). After the successful eradication, significant decreases of the degree of H. pylori infiltration (P < 0.001), serum anti-H. pylori IgG titer (P < 0.001), and serum concentrations of PG I (P = 0.028) and PG II (P = 0.028) were observed. The anti-H. pylori IgG assay can be used to estimate the burden of bacteria in immunocompetent hosts with H. pylori infection, regardless of the HBsAb titer after HBV vaccination.

The experience of dissolving polypharmacy by reducing the prescription of anti-ulcer drugs in residents of a special geriatric nursing home.

As part of a broader study on polypharmacy among elderly nursing home residents, we examined the impact of reducing or discontinuing the prescription of proton pump inhibitors and other anti-ulcer drugs. We employed a strategy of reducing and discontinuing the prescription of drugs to 160 elderly residents of the Hiroshima Atomic Bomb survivors nursing home, Kandayama Yasuragien. The residents had entered the home between April 2012 and November 2015. As part of this study into anti-ulcer drugs, we also measured the concentrations of Helicobacter pylori antigen in stool specimens, and the serum concentrations of H pylori antibodies and pepsinogen I and II. The proportions of residents who were taking more than six drugs on April 2012, August 2014 and November 2015 were 55.2%, 49.0% and 43.0%, respectively. At the same times, the proportions of residents who were taking anti-ulcer drugs were 50.0%, 49.0% and 6.0%, respectively. The presence of H pylori antigen and antibodies, and serum pepsinogen concentrations, did not influence the decisions to continue or discontinue anti-ulcer drugs. We have already reported that reduction of diuretics reduces the incidence of falls and fall-related fractures in our residents, and have demonstrated the benefits of discontinuing folic acid and drugs that are given to control hyperkalemia. In the present study, we found that many anti-ulcer drugs were also of low necessity to elderly care home residents. It is essential to examine the clinical benefits of addressing polypharmacy in elderly individuals. In the future, we intend to focus on reducing hypnotics, laxatives and other drugs.

No increase in gastric acid secretion in healthy Japanese over the past two decades.

The prevalence of gastroesophageal reflux disease (GERD) has been increasing worldwide over recent decades. A previous study demonstrated that gastric acid secretion, thought to be an important factor in the increase in the rate of GERD, in Japanese individuals increased in the era from the 1970s to the 1990s. The aim of this study was to evaluate whether gastric acid secretion has altered over the past two decades with and without the influence of Helicobacter pylori infection in nonelderly and elderly Japanese. Gastric acid secretion, the concentrations of serum gastrin, pepsinogen I, and pepsinogen II, and H. pylori infection were determined in 78 healthy Japanese subjects. The findings were compared with data obtained in the 1990s. Basal acid output (BAO) and maximal acid output (MAO) gradually decreased with age in H. pylori-negative subjects. In addition, those with H. pylori infection tended to show decreased gastric acid secretion as compared with those without infection, particularly in the elderly group. MAO decreased gradually with age in males, whereas it remained unchanged with age in females. MAO in H. pylori-negative subjects has not changed over the past two decades (17.7 mEq/h vs 17.6 mEq/h in nonelderly subjects, and 15.2 mEq/h vs 12.7 mEq/h in elderly subjects). In contrast to the increased prevalence of GERD, gastric acid secretion has not increased over the past two decades in Japanese. However, secretion has decreased with age in males but not in females, which may partly explain the sex difference in the age-related GERD prevalence.

Pathophysiology of Marshallagia marshalli in experimentally infected lambs

Species of Marshallagia are abomasal parasites in free-ranging and domesticated ungulates in temperate climatic zones throughout the world. Pervasiveness of these nematodes is significant in various parts of the world. There has been limited research in the area of Marshallagi amarshalli pathogenesis. The aim of this study was to investigate the effects of M. marshalli on the acid secretory capacity of the abomasal mucosa and the morphological changes due to parasitic migration to different parts of abomasal tissue in sheep. Ten lambs, approximately around 6 months old, were allotted to two groups of five (A and B). The sheep from group A were infected orally with a dose of 5000 third-stage larvae (L3) of M. marshalli whereas the sheep of group B were not infected. The results indicated that the development of M. marshalli in the abomasal glands of ruminants causes pathophysiological changes, which include a reduced acidity of the abomasal contents, increased abomasal pH and increased serum pepsinogen concentrations. The reduced acid secretion is explained by a replacement of functional parietal cells by undifferentiated cells. Histology changes include mucosal cell hyperplasia, loss of parietal cells and inflammatory cell infiltration, which includes numerous granulocytes and lymphocytes.