Eradication of Helicobacter pylori has no effect on gastric acidity in duodenal ulcer patients--evaluation of 24-h pH monitoring.

It is accepted that eradication of Helicobacter pylori leads to healing of chronic active gastritis facilitates ulcer healing and prevents ulcer recurrence in duodenal ulcer (DU) patients. However, it is not entirely known whether the eradication of the bacteria normalizes gastric acid secretion and abolishes dyspeptic symptoms after ulcer healing. This study was aimed to evaluate the intragastric acidity and dyspeptic complaints before, and 3 months after, eradication in 18 endoscopically proven H. pylori positive DU patients. Gastric pH was measured by 24-h continuous intraluminal recording, serum gastrin measurements and Congo-red tests were also performed. Dyspeptic complaints and antacid consumptions were recorded in diary cards, antisecretory therapy was not allowed after the cessation of eradication therapy. Endoscopy, H. pylori status and Congo-red tests were controlled at the 6th and 12th week, while pH measurements and serum gastrin tests were performed at inclusion and 3 months later. Three patients dropped out and in 14 out of the remaining subjects healing of DUs and successful eradication was achieved by the 6th and 12th week controls. The 24-h median pH and the percentage of 24-h pH readings under pH 3 were not changing significantly by the 3-month controls (from 1.9+/-0.5 to 1.8+/-0.4 and from 52.6+/-5.5% to 58.6+/-5%, respectively). Similarly, no significant changes were observed in serum gastrin levels and dyspeptic symptom scores (from 72+/-7 pg/ml to 56.7+/-8 pg/ml and from 2.69+/-0.4 to 1.26+/-0.3, respectively). The antacid consumption was almost stable when compared with the pre- and post-eradication periods. It was concluded that despite successful H. pylori eradication and healing of DU, intragastric acidity does not change significantly at least 3 months after the therapy. The persisting dyspeptic symptoms and the need for antacid consumption suggest that some healed ulcer patients require antisecretory therapy in the post-eradication period.

Genetic associations and immunopathogenesis of coeliac disease.

Coeliac disease is the most common disorder with malabsorption of the small instestine, caused by the gluten fraction of cereals in genetically predisposed individuals. Gluten peptides are efficiently presented by coeliac disease-specific HLA-DQ2- and HLA-DQ8-positive antigen-presenting cells, and thus drive the antigen-presenting cells, predominantly in the connective tissue of the lamina propria. The studying of the recently explored autoantibodies against tissue transglutaminase brought us further in the understanding of the pathophysiology of coeliac disease. The spreading of reliable serologic methods modified our knowledge on the clinical picture and prevalence of the disease. Long-standing untreated coeliac disease, even if clinically silent, predisposes for other autoimmune diseases. Therefore, population screening for immunoglobulin A antibodies to tissue transglutaminase seems justified.

[Morphologic and clinical aspects of chronic gastric erosions]. / A chronicus gastricus erosiók morphologiai és klinikai jellemzöi.

Chronic erosions of the stomach are mostly papular lesions of the gastric mucosa with large base, 0.5-1 cm in diameter, often with superficial central depression covered with fibrin, less frequently without it. The typical site of lesion is the antrum the chronic erosions are here manifold, solitary forms are infrequent. In the course of 5694 gastroduodenoscopies the authors observed in 198 patients (5.2%) typical endoscopic picture of chronic erosions. In biopsy samples volcano-type lesions of the mucous membrane characteristic of the disease were found. According to the results the chronic erosions of the stomach are lesions of aspecific symptomatology, the disturbance of the mucosal barrier cannot be made probable. It is important to know the morphological characteristics of the rather frequent independent entity also for separating it from adenomas. Malignant transformation was not found in the material of the authors.

[Ph measurement in the stomach and duodenum through endoscopy]. / Endoscopon keresztül végzett pH mérés a gyomorban és a duodenumban.

The pH values were measured by means of a flexible glass-electrode through endoscope in the stomach and duodenum. The measuring instrument and technique are described. The luminal and juxtamucosal pH values were determined. The latter indicates the pH value prevailing on the epithelial surface of the viscid mucous layer. The gradient between the two values expresses the hydrogen-ion neutralizing capacity of the viscid mucus on the surface of the mucosa. Quantitative data on the first protective line of the gastric and duodenal mucous membrane may be obtained by measuring it. The pH values at different points of the stomach and duodenum were determined through endoscope in 24 patients with duodenal ulcer and in 15 controls. No significant difference was found between the two groups concerning the gastric luminal pH values, however the luminal pH of the duodenal bulb was significantly lower in patients with duodenal ulcer than that of the controls. In patients with duodenal ulcer the juxtamucosal pH value was significantly lower at several points in the stomach and in the duodenum too as compared to the controls. This refers to the insufficient neutralizing capacity of the viscid mucous layer. The pH measurement performed through endoscope furnishes in a simple way valuable clinical data, it is furthermore the first quantitative method which can be used routine-like for the examination of the barrier function of the viscid mucous surface in the stomach and duodenum of man.