Helicobacter pylori infection in spouses of patients with duodenal ulcers and comparison of ribosomal RNA gene patterns.

BACKGROUND: In recent studies, familial coinfection with the same Helicobacter pylori strains has been indicated, but more data are necessary to confirm intra-familial spread of the micro-organism. AIMS: The aim of this study was (a) to assess the frequency of H pylori infection in spouses of patients with duodenal ulcers and (b) to investigate the possibility of intraspousal typing of the respective strains. PATIENTS: Sixty four patients with duodenal ulcer and their spouses were included in the study. METHODS: The H pylori infection was confirmed after endoscopy by culture and histological examination of biopsy specimens, and CLO test. The isolates were compared on the basis of their rRNA gene patterns (ribopatterns) after digestion of chromosomal DNA by the restriction endonucleases HaeIII or HindIII. RESULTS: Of the patients, 54 were found to be H pylori positive. Of the respective spouses, 42 (78%) were also H pylori positive. In contrast, only two out of 10 (20%) partners of H pylori negative patients were infected. Ribopatterns of H pylori strains derived from 18 patients and their spouses showed that in each of eight couples a single strain had colonised both partners, while in the remaining 10 couples each partner was colonised by a distinct H pylori strain. CONCLUSIONS: These data suggest person to person transmission within couples or exposure to a common source of infection.

Gastric epithelial polyps: a retrospective endoscopic study of 12974 symptomatic patients.

This is a retrospective endoscopic study on the incidence of gastric epithelial polyps (adenomas, hyperplastic, inflammatory) in 12,974 consecutive symptomatic Greek adults submitted to endoscopy during a 4-year period, in two endoscopy units. A total of 258 polyps were found in 157 patients (1.2%), 80 males and 77 females (age: 22-87 years); 67.5% of these patients were older than 60 years. Two hundred and two (202) polyps were totally removed. In 43 patients (27%), more than one polyp was found. Polyps were mainly hyperplastic (75.6%). Adenomas were found in 6.6%, and only in patients older than 50 years. Hyperplastic and inflammatory polyps were equally distributed in males and females. A male predominance was observed in adenomas (2:1). Most of the polyps were in the antrum (43.8%) and were hyperplastic (75.2%). Of 501 previously operated patients (gastrectomy or gastrojejunostomy), 26 (5.2%) had polyps. No adenomas were seen in the anastomosis area. Most of the polyps (61.9%) were smaller than 0.5 cm; 13.3% were greater than 1 cm. No coincidence of polyps with gastric cancer was observed.

The use of ERCP in the study of patients with hepatic echinococcosis before and after surgical intervention.

BACKGROUND: Biliary tree involvement is the most common complication of hydatid liver disease, which is difficult to detect and manage. METHODS: During the last 7 years, we examined by ERCP 26 cases with echinococcal liver involvement. Indications in the preoperative group included cholangitis in 6 cases, right-sided hypochondralgia involving 4, preoperative assessment in 4, and icterus in 1 case. In the postoperative group, the indications for ERCP were cholangitis in 5 cases, external biliary fistulas in 5, and biliary colic in 1 case. RESULTS: ERCP findings in the preoperative group included external bile duct compression in 11 cases (73.3%), biliary fistula affecting 3 (20%), and echinococcal remnants within the common bile duct in 1 case (6.6%). With regard to the postoperative group, biliary fistula formation was detected in 6 cases (54.5%), echinococcal remnants within the common bile duct in 4 (36.3%), and external bile duct compression involving 1 case (9%). Endoscopic sphincterotomy was successfully performed in 13 patients in both groups. No serious complications were encountered. CONCLUSION: ERCP is a safe and helpful preoperative or postoperative tool that aids in the diagnosis and often the treatment of echinococcal liver disease with involvement of the bile ducts.

Intraluminal duodenal diverticulum.

A 76-year-old man with an iron deficiency anemia during the previous 4 years and recent melena was presented. Gastroscopy showed a sessile polypoid lesion in the area of the papilla of Vater and histology was normal. Barium swallow follow-through and CT scan revealed a round intraluminal filling defect. ERCP demonstrated extrinsic compression of both ducts. Emergency laparotomy was performed because of upper GI bleeding and because attempts at endoscopic haemostasis of the oozing polypoid mass were unsuccessful. A soft compressible polypoid mass was found, which on palpation excreted a viscous milky liquid through a tiny opening. Histology showed normal duodenal mucosa bilaterally, a diagnostic finding of intraluminal duodenal diverticulum. The atypical age of presentation as well as gastroscopic and roentgenographic findings of this rare entity are illustrated.

Colonic findings in cirrhotics with portal hypertension. A prospective colonoscopic and histological study.

Total colonoscopy was performed in 38 consecutive cirrhotics (15 alcoholic, 19 postviral, four unknown) with portal hypertension, 32 of whom were enrolled in a program of esophageal sclerotherapy because of variceal bleeding (Child's grading: A, 13; B, 21; C, 4 patients). In 34 of them, multiple biopsies from the colonic mucosa were taken. Fifty non-cirrhotics (roughly matched for age and sex with the patients) who were colonoscoped because of atypical abdominal complaints, served as controls for rectal varices, polyps, and hemorrhoids. Rectal varices occurred in 3 of 38 (7.9%) of cirrhotics with portal hypertension; they were found only in those who had undergone esophageal sclerotherapy, but no association with the number of sclerotherapies was documented; severity and etiology of cirrhosis did not seem to influence their presence. Hemorrhoids and polyps did not seem to occur more frequently in cirrhotics than in controls. Nonspecific inflammatory changes were observed macroscopically in 57.9% of the patients; these were significantly more common in postviral cirrhosis in comparison with alcoholic cirrhosis (p = 0.01967; 95% CI, 0.757-0.155) and, in particular, in the Child's B postviral cirrhosis as compared with the Child's B alcoholic cirrhosis (p = 0.01915; 90% CI, 0.942-0.320). In 15 patients, there was histological evidence of chronic or acute nonspecific inflammation; no associations with the severity or the etiology of the cirrhosis were found. No vascular ectasias or ectasia-like lesions were found.

In vitro binding of Helicobacter pylori to human gastric mucin.

The in vitro binding of four Helicobacter pylori strains to human gastric mucin was studied with an enzyme-linked immunosorbent assay. All four strains were found to bind to purified mucin. Neuraminidase treatment and nonspecific oxidation of mucin decreased bacterial adherence to the macromolecule. Mucin preparations were also found to inhibit attachment of H. pylori to HEp-2 monolayers.

ABO blood group, secretor status and detection of Helicobacter pylori among patients with gastric or duodenal ulcers.

Patients (454) referred for gastroscopy to the General Hospital of Athens were examined to determine (1) if non-secretors were over-represented among patients with ulcers and (2) if there was an association with ABO blood group or secretor status and carriage of Helicobacter pylori. Compared with the local population, among patients with either gastric ulcer (51) or duodenal ulcer (96) there was a significant increase in the proportion of those who were blood group O (P less than 0.025); however, there were no significant differences in the proportions of non-secretors. H. pylori was identified in 62% of the 454 patients: 59.5% of those without evidence of ulcers; 62.5% of those with gastric ulcer; 88% of those with duodenal ulcer (P less than 0.0005). These bacteria were cultured more often and in higher numbers from patients with duodenal ulcer (P less than 0.025). There was no association between ABO blood group and prevalence of H. pylori. The prevalence of H. pylori among non-secretors with gastric ulcer (12.5%) was significantly lower than that for non-secretors with duodenal ulcer (100%) (P less than 0.0005). This was not observed for secretors.

Inhibition of Helicobacter pylori haemagglutination activity by human salivary mucins.

Thirty isolates of Helicobacter pylori from gastric biopsies agglutinated human erythrocyte suspensions. Crude mucin preparations derived from saliva of 20 different donors were examined for their ability to inhibit haemagglutination. All mucin preparations exhibited strong inhibitory activity. Removal of sialic residues from mucin preparations by treatment with neuraminidase resulted in a substantial reduction of their inhibitory activity. The mucin preparations had no bactericidal or aggregation activity for H. pylori. These results are discussed in the context of the role of mucins in colonization of the gastric mucosa by H. pylori.

Seroepidemiology of Helicobacter pylori infection in Greece.

Helicobacter pylori infection is strongly associated with chronic gastritis and peptic ulceration. As the prevalence of H. pylori infection in southern European populations is not known, a serological survey of 1069 samples from three different age groups in the Greek population was carried out with an enzyme-linked immunosorbent assay (ELISA) for antibodies to these bacteria. The antigen was an ultracentrifuged supernate of whole cell sonicates of 5 isolates of H. pylori assessed by electrophoresis and by immunoblotting with negative and positive sera. The sensitivity of the test was 97.43% and the specificity 100% for IgG antibodies; IgA and IgM antibodies to the antigen preparation were not found. Antibodies to H. pylori were detected among 39.4% of children aged 1-10 years, 67.1% of recruits (20-27 years) and 70% of blood donors (20-50 years). The prevalence of antibodies did not differ with sex in each of the age groups. The proportion of individuals with antibodies to H. pylori was higher in the younger age groups than those reported for similar age groups in western Europe.

The efficacy of amineptine in the treatment of depressive patients with irritable bowel syndrome.

Patients with irritable bowel syndrome (IBS) often suffer from depression. In view of this, the effect of amineptine on the psychopathological condition of depressive patients with IBS was studied. Forty patients who satisfied the criteria for irritable bowel syndrome and had a Hamilton 24-item score above 15 were randomly assigned to receive either amineptine 200 mg/day or placebo in a double-blind clinical trial. Patients on amineptine were more improved at the end of the trial than patients on placebo (total Hamilton score). Amineptine was more effective on depressive mood, retardation, and cognitive dysfunction. Although these findings should be interpreted with caution because the baseline scores were higher in the amineptine than in the placebo group, they provide some evidence that amineptine may be a useful tool for the management of depressive patients with IBS.

Specificity of antibodies secreted by hybridomas generated from activated B cells in the mesenteric lymph nodes of patients with inflammatory bowel disease.

Hybridomas have been prepared from active B cells in lymphoid tissue draining lesions of Crohn's disease (CD) and ulcerative colitis (UC), by fusion of fresh mesenteric lymph node suspensions with the murine JK myeloma. Two hundred and fifty nine immunoglobulin secreting hybridomas have been obtained from nine patients. The antibodies have been screened for binding to food antigens, sections of human gut, and bacteria including two unidentified acid fast isolates from CD lymph nodes. Autoantibodies, and antibodies to food antigens implicated by others in the aetiology of CD were rare, comprising 1.2%, and 2.5% respectively. Most donors yielded none of these. Thus neither food antigens nor autoantigens are major antigenic stimuli in nodes draining inflammatory bowel disease. On the other hand between 19% and 83% of supernatants from different donors bound to one or more bacterial genus. The mycobacteria and the CD isolates were amongst the genera to which most antibodies bound, though binding to E coli was more frequent. Significantly more CD than UC derived supernatants bound to BCG. As mycobacteria are not though to be part of the normal bowel flora, the high percentage of hybridomas secreting antibodies which bind to this genus is surprising.

Angiodysplasia--an uncommon cause of colonic bleeding: colonoscopic evaluation of 1,050 patients with rectal bleeding and anaemia.

Angiodysplasia of the colon was diagnosed in 31 out of 1,050 patients (3%) presenting with rectal bleeding or anaemia, among 10,000 colonoscoped at St. Mark's Hospital. The lesions were identified in 16 out of 879 (2%) patients with rectal bleeding, in 15 out of 171 (9%) patients with anaemia, and in a further three patients without features of blood loss. The angiodysplasia lesions were predominantly in the right colon (76%) and occurred with a similar frequency (12%) in the transverse and the left colon. Affected patients (59% male and 41% female) were in the older age group (53-89 years; mean age 69.5 years) but only one patient had known aortic valve disease. Angiodysplasia is an important diagnosis to consider in patients presenting with colonic bleeding or anaemia because it can be treated in the majority of cases by endoscopic electrocoagulation. However in our experience it is less common (3%) than previously suggested by other authors (40-67%). Endoscopic over-diagnosis is possible when intramucosal capillaries with no bleeding tendency on local traumatisation or biopsy are included in the diagnosis but these lesions are not true angiodysplasia.

Prednisolone absorption in inflammatory bowel disease: correlation with anatomical site and extent.

Prednisolone absorption was studied in 13 normal subjects, eight patients with ulcerative colitis and 21 patients with Crohn's disease, by measuring plasma levels after a single oral dose. Absorption of the drug was delayed in all patient groups. The peak plasma level of the drug was lower in patients with extensive small bowel Crohn's disease. Patients in this category may need higher doses of oral prednisolone than other patients with inflammatory bowel disease.

Ulcerative colitis with relative sparing of the rectum. Clinical features, histology, and prognosis.

A series of 12 patients with relative sparing of the rectum in ulcerative colitis is analyzed. Half were recorded as having normal sigmoidoscopic appearance and, in every case, double-contrast barium enema showed an apparently normal rectum but an abnormal colon. Rectal biopsy showed changes compatible with ulcerative colitis in all cases, though in four, changes were slight. Thus, complete histologic sparing of the rectum was not observed. In four of six patients treated by colectomy and ileorectal anastomosis, inflammation of the retained rectum required medical or surgical treatment.

Histocompatibility antigens (HLA-A, B) and ulcerative colitis in a Greek population.

Histocompatibility antigens (HLA-A, B) have been studied in 70 patients with ulcerative colitis of Greek origin. An increased frequency of HLA-A11, B7 and B13 (RR 2.1, 2.0 and 4.5, respectively) and a decreased frequency of HLA-B14 (RR 0.2) were found. Severe course of the disease was associated mainly with HLA-B13 (RR 5.5) whereas extensive spread of the colitis was associated with HLA-A11 and B7 (RR 2.6 and 3.2). Late onset of the disease (greater than 30 years) was characterized by increased frequency of HLA-A11, B7 and B13.