Protective effect of ascorbic acid in experimental gastric cancer: reduction of oxidative stress.

AIM: Oxidative stress participates in the cell carcinogenesis by inducing DNA mutations. Our aim was to assess whether ascorbic acid, an antioxidant, could have a role in preventing ROS (Reactive Oxygen Species) generation in experimental gastric carcinoma in a rat model. METHODS: Experimental gastric cancer was induced in twelve Wistar male rats (weighting 250-350 g) by profound duodeno-gastric reflux throught split gastrojenunostomy. The rats were allocated to the following groups: Group I (n=6) was the control; Group II (n=6) which was mantained with daily intake of tape water with Vitamin C (30 mg/Kg). After 6 or 12 months, samples of gastric tumor or non tumor mucosa were taken from the anastomosis of both groups. Oxidative stress was measured by superoxide quantification through lucigenin-amplified chemiluminescence base and by staining with Nitrobluetetrazolium. The histopathologic confirmation of adenocarcinoma was made by eosin-hemathoxilin method. RESULTS: The intestinal type of gastric adenocarcinoma was microscopically identified in all animals of group I whereas only 3 rats of group II showed an adenocarcinoma without macroscopic evidence of them. The cancers were located in the anastomosis in all cases. Basal luminescence from tumor gastric tissue generated 38.4+/-6.8 count per minute/mg/X10(6) (mean+/-SD) and 14.9+/-4.0 count per minute/mg/X10(6), respectively, in group I and II animals (P<0.05). The Nitrobluetetrazolium method showed intense staining in tumor tissues but not in non neoplasic mucosa. CONCLUSION: Experimental gastric tumors seem to produce more reactive oxygen species than non neoplasic gastric tissue. The reduction of oxidative stress and gastric tumor incidence in rats were induced by the intake of ascorbic acid. Therefore, it may have a role in the prevention of gastric carcinoma.

Helicobacter pylori recurrence in patients with duodenal ulcer: Clinical, endoscopic, histologic, and genotypic aspects. A 10-year Brazilian series.

BACKGROUND: Recurrence infection following successful eradication of Helicobacter pylori is usually low, except for countries with high prevalence of H. pylori. The aim of this study was to verify H. pylori recurrence rate in patients with duodenal ulcer after eradication and the possible relationship with environmental factors, histologic pattern of the mucosa and bacterial genotype. MATERIALS AND METHODS: One-hundred and ninety-four patients with an active duodenal ulcer and who were successfully treated for H. pylori infection from 1990 to 1999 were studied. A questionnaire was answered about their living conditions, and a 14C-urea breath test was performed. Patients with a positive breath test underwent an upper endoscopy to investigate for possible ulcer recurrence; gastric biopsy samples were than collected for rapid urease test and for histologic assessment. H. pylori vacA and cagA genotype was determined by polymerase chain reaction in those samples with positive urease test. RESULTS: H. pylori infection was detected in 11 patients (recurrence rate of 5.7%) that were not associated with the type of bacterial virulence. In 10 patients the ulcer was healed and all of them were clinically asymptomatic. In eight, histology showed an intensification of gastritis. All 11 patients had adequate housing and sanitary conditions and no other risk for H. pylori recurrence was identified. CONCLUSIONS: The recurrence rate of H. pylori in Brazil was higher than that reported in developed countries, but lower than usually reported in developing ones. Ulcer relapse rarely occurs even in long-term follow up.

Cytotoxic T lymphocyte antigen-4 gene polymorphisms do not confer susceptibility to autoimmune hepatitis types 1 and 2 in Brazil.

OBJECTIVE: Susceptibility to autoimmune hepatitis (AIH) has been linked to different HLA-DR antigens in distinct populations. Recently, an A-G polymorphism in exon 1 of the cytotoxic T lymphocyte antigen-4 (CTLA-4) gene was associated with predisposition to AIH type 1 (AIH-1) in white individuals in North America. This polymorphism has been associated with several other autoimmune diseases, presumably because of its effect in the expression of CTLA-4, an adhesion molecule that downregulates peripheral T cell responses. The aims of this study were to assess the frequency of CTLA-4 genotypes in Brazilian patients with AIH-1 and AIH type 2 (AIH-1), as well as to investigate the influence of these genotypes in disease expression. METHODS: Determination of CTLA-4 genotypes was carried out in 106 patients with AIH-1, 26 subjects with AIH-2, and 67 healthy control subjects by polymerase chain reaction (PCR)-based techniques. RESULTS: No difference in the distribution of CTLA-4 genotypes was observed in subjects with AIH-1 and AIH-2 as compared to healthy controls. Patients with AIH-1 and AIH-2 with the GG genotype exhibited lower gamma-globulin and ALT levels, respectively. CONCLUSIONS: Susceptibility to AIH-1 and AIH-2 in Brazilian patients is not influenced by exon 1 CTLA-4 gene polymorphisms at position 49.

Ursodeoxycholic acid ameliorates experimental ileitis counteracting intestinal barrier dysfunction and oxidative stress.

The aim of this study was to evaluate the effect of ursodeoxycholic acid (UDCA) on intestinal permeability (IP) and reactive oxygen species (ROS) generation in indomethacin-induced enteropathy, a well-known experimental model of Crohn's disease. Seventy-eight male Wistar rats were randomly assigned to receive indomethacin, indomethacin + UDCA, or vehicles. Indomethacin induced a significant increase in the fraction of urinary excretion of 51Cr-EDTA following oral administration (7.9 +/- 1.3 vs 2.3 +/- 0.2%; P < 0.05) and lucigenin-amplified chemiluminescence in intestinal fragments ex vivo (10.1 +/- 1.9 vs 2.6 +/- 0.4 cpm x 10(3)/mg; P < 0.05) compared to controls. UDCA significantly reversed these effects (P < 0.05), without being incorporated in biliary bile acid composition (HPLC analysis). These findings support a local protective effect of UDCA in experimental ileitis by the modulation of intestinal barrier dysfunction and oxidative stress. In short, they provide insights into mechanisms of action of UDCA in intestinal inflammation and a new perspective on the treatment of Crohn's disease.

Espessamento ultra-sonográfico da parede vesicular na hepatite alcoólica: condiçöes näo cirúrgicas / Sonographic thickening of the gallblader wall in alcoholic hepatitis: a non-surgical condition

Os autores assinalam, pela primeira vez na literatura, o freqüente achado de espessamento ultra-sonográfico das paredes da vesícula biliar na hepatite alcoólca. Dentre 19 pacientees encontraram expessamento ecográfico da parede vesicular em 14 (73,5%). Em dois pacientes a vesicula mostrou-se com características de vesícula de escasso conteúdo ("vesícula murcha"). Alertam clínicos e cirurgiöes a propósito do espessamento ultra-sonográfico da parede vesicular na hepatite alcoólica, diagnóstico que deve afastar o paciente de qualquer intervençäo cirúrgica, por ser contra-indicada e até fatal. Assinalam a atençäo que se deve ter no diagnóstico diferencial entre hepatite alcoólica e colecistite aguda, pois que a primeira pode ocasionar, além do espessamento mural, leucocitose com desvio a esquerda, dor no hipocôndrio direito e até mesmo descompressäo brusca dolorosa no ponto vesicular

Gastroduodenite erosiva associada a Cryptosporidium num paciente com síndrome de imunodeficiência adquirida / Erosive gastroduodenitis associated with Cryptosporidium in a patient with acquired immunodeficiency syndrome

É relatado um paciente com a síndrome de imunodeficiência adquirida, diarréia e vômitos persistentes. Esofagogastroduodenoscopia com biopsias da mucosa esofágica, gástrica e duodenal revelou gastroduodenite erosiva com presença de Cryptosporidium sp. Exames proctológico mostrou um quadro de proctite e a biopsia retite crônica inespecífica com presença de Cryptosporidium sp

Variation and physiological significance of basal gastrinemia in normal children

É verificada a variaçäo dos volumes da gastrinemia basal em crianças brasileiras de diferentes faixas etárias. Níveis basais de gastrinemia foram determinados por radioimunoensaio, em 30 crianças normais, de idade variando de 2 meses a 9 anos, divididas em três grupos: 1) 11 crianças de 2 a 6 meses; 2) nove crianças de 7 a 18 meses, e 3) 10 crianças de 20 meses a 9 anos. Os niveis de gastrinemia basal variaram de 11-533 pg/ml (x = 139,46 D.P. = 131,55). Houve correlaçäo estatisticamente significante entre estes valores e as idades das crianças. A diferença das médias mostrou-se estatisticamente näo significante entre os grupos 1(x=191,82 e D.P. = 116,26) e 2(x = 186,11 e D.P. = 161,65), porém significante entre os grupos 1 e 3 (x = 36,9 e D.P. = 17,67), assim como entre os grupos 2 e 3. Os resultados demonstram que os níveis basais de gastrinemia em crianças normais variam inversamente com a idade, sendo os maiores valores observados na faixa etária até 18 meses. A seguir ocorre diminuiçäo acentuada da gastrinemia basal atingindo níveis semelhantes aos referidos para adultos. Os autores especulam se a hipergastrinemia observada no presente estudo näo seria indicativo de uma importante funçäo fisiológica no desenvolvimento ontogenético do estômago

Inibidor de bomba de protônica pantoprazol em dose plena no tratamento das doenças ácido-relacionadas. Estudo ambulatorial brasileiro / Proton pump inhibitor - Pantoprazole 40 mg - in the trteatment of acid related diseases

Os inibidores de bomba platônica (IBPs) têm elevado significado significativamente os índices de cicatrizaçäo das doenças ácido-relacionadas com mínimos eventos adversos. Pantoprazol é um IBP com propriedades farmacológicas definidas, intensa açäo anti-secretora e elevada eficácia clínica. O objetivo deste estudo foi avaliar a eficácia e a segurança de pantoprazol, 40 mg, em uma populaçäo näo selecionada, portadora de doenças ácido-relacionadas. Em estudo aberto, prospectivo, näo randomizado, ambulatorial, foram avaliados 2.222 pacientes (média etária de 44,3 anos) divididos em três grupos. Todos os pacientes receberam pantoprazol, 40 mg/dia, durante duas a oito semanas. Os índices de cicatrizaçäo da UG e DU foram 71,6 porcento e 81 porcento, respectivamente. Os índices de cicatrizaçäo das esofagites de refluxo foram de 81,2 porcento, 67,7 porcento, 50 porcento e 36,1 porcento nos graus I, II,III e IV, respectivamente, de acordo com a classificaçäo de Savary-Miller. A maioria dos eventos adversos foram leves e ocorreram em 2,5 porcento dos pacientes. Os mais freqüentemente relatados foram cefaléia, diarréia, prurido, constipaçäo e tontura. A eficácia do pantoprazol no tratamento das doenças ácido-relacionadas foi demonstrada. O bom perfil de tolerabilidade confirma a segurança do produto.(au)

Dispepsia näo-ulcerosa / Non ulcer dyspepsia

Non ulcer dyspepsia is defined as the presence of pain and/or discomfort localized to the upper abdomen, episodic or persistent, with a duration superior of 4 weeks, in the absecence of any organic lesion or sistemic disease. In order to facilitate its management, non ulcer dyspepsia is classified in five typres: 1) gastroesophageal reflux disease; 2) ulcer-like disease; 3) motility disorders; 4) aerophagia; 5) diopatic. The main clinic and pathophysiologic characteristics of each type are discussed. The diagnosis is basead in the clinical picture and in the negative results of some exams (endoscopy, ultrasound) and sugestive results of others (manometry, contrast X-ray, 24 hour pHmetry and gastric emptying time). The treatment may be divided in general (diet, behaviour, phychologic measures) and pharmacological approach (antiacids, H2blockers, procinetic agents). Each case should be individualized in terms of the presence of its main symptoms. Emphasis is put on the psychologic features and their adequate approach by the physician

Síndrome poliglandular autoimune do tipo I com hipoparatireoidismo, candidíase mucocutânea crônica e malabsorçäo intestinal / Polyglandular autoimmune syndrome type I with hypoparathyroidism chronic mucocutaneous candidiasis and intestinal malabsorption

A ocorrência de candidíase mucocutânea crónica e hipoparatireoidismo (síndrome poliglandular auto-imune do tipo I) é descrita em uma paciente de 13 anos. Além de candidíase desde os 3 anos, apresentava convulsöes desde os 6 anos, cataraata aos 9 anos, alteraçöes dentárias e calcificaçöes dos gánglios da base. Os exame laboratoriais confirmaram o diagnóstico de hipoparatireoidismo. Este quadro era acompanhado por uma malabsorçäo intestinal, levando a paciente a um estado de desnutriçäo progressiva, com hipoalbuminemia importante e anemia. Embora a fisiopatologia da malabsorçäo, nesses casos, ainda näo esteja esclarecida, a resposta terapêutica à pancreatina, na presente observaçäo, foi sugestiva de haver insuficiência pancreática, mesmo porque a provada d-xilose foi normal e a biopsia do delgado inespressiva

Trombocitose e doença de Crohn / Thrombocytosis and Crohn disease

A correlaçäo entre trombocitose e atividade da doença de Crohn (DC) tem sido constatada por alguns autores. Entretanto, esta observaçäo näo tem sido extensamente utilizada pela existência de comprovaçöes limitadas. Assim, os autores analisaram, retrospectivamente, os dados dos últimos 30 pacientes atendidos na Disciplina de Gastroenterologia do Departamento de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, e na clínica privada de um dos autores (A.B.). Levou-se em consideraçäo a contagem de plaquetas (método de Brecher-Cronkite; valores normais 200.000 a 400.000 plaquetas/mm3) e o índice clínico de atividade da DC segundo os critérios de Harvey e Bradshaw. Onze pacientes (37%) apresentaram trombocitose (x=500.818 + ou - 56.845) e o valor médio do índice clínico de atividade desse grupo foi 8,6 (intervalo de confiança: 6-13). Dezenove pacientes (63%) näo apresentaram trombocitose (267.789 + ou - 62.124) e o seu valor médio de atividade foi 5,7 (intervalo de confiança: 2-11). Diferença estatisticamente significante foi verificada entre os valores médios dos índices clínicos de atividade dos dois grupos (z=2,84, para alfa < ou = 0,05), bem como entre as médias do número de plaquetas/mm3 (z = 4,5, para alfa < ou = 0,05). Näo houve relaçäo estatisticamente significante entre trombocitose e formas íleo-cólica, jejuno-ileal e cólica da DC. Entretanto, dos nove pacientes da casuística com forma ileal, oito (88%) näo apresentaram trombocitose e tiveram índices de atividade < ou = 6. Os possíveis mecanismos fisiopatológicos da trombocitose na DC säo comentados e revisados. A relaçäo entre trombocitose e a atividade da DC, observada na presente casuística, näo constitui, certamente, elemento diagnóstico para a afecçäo, mas associadamente ao quadro clínico, pode representar importante parâmentro para indicar a atividade da doença