[Intestinal helminthiasis--general practice problem of the gastroenterologist]. / Intestinale Helminthosen--Praxisproblem des Gastroenterologen.

In case of nonspecific, not constantly occurring abdominal symptoms the investigator should be aware of invermination, especially when immigrants or tourists returning from far regions complain about diarrheal tendency, stomach ache, nausea or hepatic and biliary symptoms. Intestinal helminthism is spread all over the world. Some of these diseases are limited to warm regions, but they are more and more often seen in our gastroenterological outpatient departments. Nematodes are found most frequently, with a predominance of Ascaris, Trichuris, and Enterobius. But Ancylostoma and Strongyloides are not seldom, too. Concerning Cestodes, Taenia and Vampirolepis are predominant. Trematodes = Fasciola, Echinostoma, Schistosoma are less frequent. Larva migrans, Acanthocephala and Dipylidium sometimes cause considerable diagnostive problems. Classification of macroscopic and microscopic findings is decisive for the therapeutic strategy. For nematodiasis Mebendazole (Vermox, Surfont), Pyrantelembonate (Helmex), Pyrviniumembonate (Molevac, Pyrcon) are effective. Albendazole (Eskazole) is approved for strongyloidiasis. For cestodiasis Niclosamid (Yomesan) and Praziquantel (Cesol) are suited. Higher doses of Praziquantel (Biltricide) are recommended for trematodiasis. During pregnancy and lactation period absorbable anthelmintics have to be avoided.

Role of the systemic cellular immune response in the pathogenesis of Helicobacter pylori-associated duodenal ulcer.

20 patients colonized by H. pylori (9 with duodenal ulcer, 11 with antral gastritis) were examined for the presence of a systemic cellular immune response to H. pylori using an in vitro lymphocyte transformation assay. Infiltration of the antral mucosa by myelomonocytic cells was assessed by immunohistology as a parameter of local cellular immune response. A systemic H. pylori-induced cellular reaction could be demonstrated in 11 patients all of whom showed an intense myelomonocytic infiltration of the antral mucosa. In this group 7 of 9 duodenal ulcers occurred. The findings support the hypothesis, that a specific cellular immune response might be involved in the pathogenesis of H. pylori-associated gastritis and duodenal ulcer. A protective role of systemic cellular immunity to H. pylori seems rather unlikely.

[Persorption of microparticles]. / Persorption von Mikropartikeln.

Solid, hard microparticles, such as starch granules, pollen, cellulose particles, fibres and crystals, whose diameters are well into the micrometre range, are incorporated regularly and in considerable numbers from the digestive tract. Motor factors play an important part in the paracellular penetration of the epithelial cell layer. From the subepithelial region the microparticles are transported away via lymph and blood vessels. They can be detected in body fluids using simple methods: only a few minutes after oral administration they can be found in the peripheral blood-stream. We observed their passage into urine, bile, cerebrospinal fluid, the alveolar lumen, the peritoneal cavity, breast milk, and transplacentally into the fetal blood-stream. Since persorbed microparticles can embolise small vessels, this touches on microangiological problems, especially in the region of the CNS. The long-term deposit of embolising microparticles which consist of potential allergens or contaminants, or which are carriers of contaminants, is of immunological and environmental-technical importance. Numerous ready-made foodstuffs contain large quantities of microparticles capable of persorption.

Comparative demonstration of IgE (immunoglobulin E) in the gastric mucosa using monoclonal and polyclonal antibodies.

It was the aim of this study to examine by using biopsy material the suitability of polyclonal and monoclonal antibodies against human IgE to support the clinical diagnosis of gastrointestinal allergy by means of morphological methods. A total of 190 gastric biopsies were collected from 56 ambulant patients; 95 specimens were shock-frozen in liquid nitrogen and treated with monoclonal antibodies (D epsilon 1, D epsilon 2); 95 biopsies were fixed in Bouin's solution, embedded in paraffin and treated with a polyclonal antibody. The slide preparations were examined semiquantitatively. The monoclonal (D epsilon 2) and the polyclonal antibody yielded different staining patterns. The polyclonal antibody mainly stained plasmocytes as constituent parts of the inflammatory infiltrate, which was regarded as a secondary phenomenon following the disruption of the mucus barrier. The monoclonal antibody mainly labeled mast cells within the glandular body of the antral and corpus-type mucosa; this finding we regarded as the most important one in the context of allergic reactions. The employment of the two different methods yielded a complete distribution of IgE-containing cells in the gastric mucosa. The immunohistochemical demonstration of IgE is therefore a useful method to support the clinical diagnosis of allergic processes in the gastrointestinal mucosa.

[Lysozyme and lactoferrin in normal and inflammatory changes of the gastric mucosa]. / Lysozym und Laktoferrin in der normalen und entzündlich veränderten Magenschleimhaut.

A total of 238 randomly selected gastric biopsies were examined with polyclonal antibodies from rabbits (antihuman-lysozyme and antihuman-lactoferrin) using the Peroxidase-Antiperoxidase-method according to Sternberger. The preparations were evaluated by comparing the intensity of the staining as well as the quantity and distribution of positive cells within the mucosa. The results show that lysozyme can be demonstrated constantly in the glandular neck zone and in the mucoid glandular body within the normal non-inflamed mucosa of the antrum, whereas in the normal corpus mucosa only a small amount of lysozyme appears focally and inconsistently in the neck area of the glands. A substantial increase in the intensity of lysozyme presentation due to inflammatory changes as related to the chronic superficial gastritis of the antrum cannot be discovered. On the contrary, the presentable amount of lysozyme decreases in line with the progressing inflammation and, in case of chronic-atrophic gastritis with intestinal metaplasia is restricted to the Paneth cells. A distinct and constant presentation of lysozyme can be achieved in the glandular neck zone, in the lower gastric pits and partially in the upper glandular body of the corpus mucosa in cases of chronic inflammatory processes. Obviously lysozyme is formed in the epithelial cells and not taken up from other cells. Furthermore it can be concluded from the findings that to a large extent lysozyme formation is linked to the proliferation activity of the epithelial cells. Lactoferrin cannot be found in normal non-inflammatory mucosa neither of the antrum nor of the corpus. But it can be found among most of the biopsy specimens with inflammatory changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastritis and bacterial colonization of the gastric mucosa in adolescents.

Among 256 examined gastric biopsies from 200 adolescents, inflammatory changes were found strikingly often: 44.5% showed chronic superficial gastritis without atrophic processes. However, the percentage of biopsies of normal mucosa was substantially higher than that of a compared series of biopsies not selected according to age of the patients. According to our findings in adolescents, the interstitial stroma of normal gastric mucosa in the antrum, as well as in the corpus, was absolutely free of round cells. Bacterial colonization with Campylobacter-like organisms (CLO) occurred almost as frequently as in the series not selected according to age. Consequently, the biopsy material of adolescents substantially more often featured normal mucosa with bacterial colonization, mostly of the minimal focal variety, than did the compared series. Colonization with CLO apparently takes place at an early age, and may exacerbate into a massive colonization.

[Immunohistochemical demonstration of the proliferation zone of the gastric mucosa]. / Zur immunhistochemischen Darstellung der Proliferationszone der Magen-schleimhaut.

The area of proliferation in the mucosa of the gastric antrum and fundus was demonstrated immunohistochemically in an unselected sample of biopsy material using the monoclonal antibody Ki 67. The findings in normal noninflamed preparations were compared with preparations of chronic superficial gastritis and a small group of advanced, partially atrophic gastritis. In all preparations the site of the proliferation was typically in the neck of the gastric glands and in the lower area of the gastric pits. However, in the fundus these areas were much narrower than in the antrum. Only isolated positively labelled cells were found outside the proliferation zone in the specific gland body and in the upper part of the gastric pits near the surface of the mucosa. There was a distinct increase of the breadth of the proliferation zone and the labelling index in chronic inflammatory processes. However, pronounced spreading or displacement of the proliferative cell population to the surface was not shown. In all preparations the areas of proliferation contained both positively labelled cells within the cell cycle and varying numbers of nonlabelled nuclei, which may be considered to be a resting reserve population.

[Long-term studies of colonization of the gastric mucosa by Campylobacter pyloridis]. / Langzeitbeobachtungen zur Magenschleimhautbesiedlung durch Campylobacter pyloridis.

Multiple biopsy specimens of gastric mucosa of 15 patients taken at different intervals with an observation period of 4 to 20 years were evaluated. Histological examination revealed superficial gastritis in most cases without radical and progressive destruction of the mucosa and in all but one case the presence of CLO was demonstrated with varying degree of intensity. No evidence was found for causal relationship between bacterial colonization and inflammation.

[Bacterial colonization of the gastric mucosa]. / Untersuchungen zur Frage der bakteriellen Besiedlung der Magenschleimhaut.

In 380 histologically prepared biopsy specimens taken from the mucous membrane of the stomach, the employment of Giemsa staining and Warthin-Starry silver staining has revealed an often surprisingly abundant (i. e., to the extent of 66.1%) bacterial colonization of the surface of the gastric mucous membrane and of the gastric foveolae. The bacteria encountered here involve gram-negative and morphologically uniform flora of thin, S-shaped or slightly curved bacteria designated as campylobacter-like organisms (CLO). Evidence for Campylobacter pyloridis was also obtained in 55.1% of cultures from 49 native, microbiologically prepared gastric biopsy specimens. Bacterial colonization of the gastric mucous membrane by CLO is definitely correlated with inflammatory alterations in gastric membranes. Active forms of gastritis, however, are not more abundantly colonized by bacteria than are dormant forms. The positive correlation between inflammatory gastric alterations of various degrees and bacterial colonization of the gastric mucous membrane, furthermore, is not proof of an etiological relationship. These bacteria, obviously adapted to the mucus in the gastric foveolae and on the surface of stomach lining, are not evidence of an aggressive behavior or of penetration tendencies. Facultatively pathogenetic significance cannot, however, be excluded for bacteria occurring in such abundance in intimate epithelial contact. Pathogenetic influence of abundant colonization by CLO could well develop if additional noxae become effective.

[The question of IgE activity in the mucosa of the large intestine]. / Untersuchungen zur Frage der IgE-Reaktivität der Dickdarmschleimhaut.

The importance of the IgE mediated inflammatory process of the large bowel mucosa was investigated by examining rectal biopsies using the peroxidase-antiperoxidase method in 172 patients to demonstrate IgE cells in the inflammatory infiltrate. IgE-positive cells could be demonstrated in small numbers in all specimens. The numeration of the plasma cells in the inflammatory infiltrate showed in most cases between 1 and 3% positive cells, only in four specimens between 5 and 6% and in two over 10%. The four groups of the specimen biopsied showed no difference in the frequency of IgE cells. The larger number of such cells in colitis ulcerosa should be viewed as the result of the more intense inflammatory process in the specimen. There was no difference either in the frequencies of mast cells in the mucosa. The findings of this investigation do not support a causative role of IgE mediated processes, in particular of the chronic inflammatory bowel disease.

[Comparative studies of IgE content of the gastric mucosa in various forms of gastritis]. / Vergleichende Untersuchungen zum IgE-Gehalt der Magenschleimhaut bei verschiedenen Gastritisformen.

The problem of the pathogenetic significance of IgE-mediated inflammatory processes in simple unspecific gastritis was studied in mucosal biopsies of 396 cases with unequivocal histological classification. The results demonstrate that only in acute and erosive gastritis high IgE cell counts are found, thus, indicating a pathogenetic significance. Furthermore the statistical evaluation showed a parallel age distribution of IgE containing cells in the four biopsy groups. Mucosal biopsies from patients 40-65 years of age exhibited higher IgE cell counts than younger and older persons. These results suggest that there is a higher IgE-reactivity in the middle age.