Alcohol dehydrogenase (ADH) isoenzymes and aldehyde dehydrogenase (ALDH) activity in the sera of patients with acute and chronic pancreatitis.

OBJECTIVE: Acute and chronic pancreatitis is a major complication of alcohol abuse. The pancreas can metabolize ethanol via oxidative pathway involving the enzymes - alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) as well as the nonoxidative pathway. Human pancreas tissue contains various ADH isoenzymes and possesses also ALDH activity. In this paper we have measured the activity of alcohol dehydrogenase isoenzymes, and aldehyde dehydrogenase in the sera of patients with acute and chronic pancreatitis. METHODS: Serum samples were taken for routine biochemical investigation from 46 patients suffering from acute pancreatitis and 32 patients with chronic pancreatitis. Total ADH activity was measured by photometric method with p-nitrosodimethylaniline (NDMA) as a substrate and ALDH activity by the fluorometric method with 6-methoxy-2-naphtaldehyde as a substrate. For the measurement of the activity of class I isoenzymes we employed the fluorometric methods, with class-specific fluorogenic substrates. The activity of class III alcohol dehydrogenase was measured by the photometric method with n-octanol and class IV with m-nitrobenzaldehyde as a substrate. RESULTS: A statistically significant increase of class III alcohol dehydrogenase isoenzymes was found in the sera of patients with acute and chronic pancreatitis. The median activity of this class isoenzyme in the patients group increased about 35% in the comparison to the control level. The total alcohol dehydrogenase activity was also significantly higher (23.5%) among patients with pancreatitis than healthy ones. The activities of other tested ADH isoenzymes and total ALDH were unchanged. The activity of the class I ADH isoenzyme was significantly higher in the sera of heavy drinkers with pancreatitis. CONCLUSION: We can state that the increase of the activity of class III alcohol dehydrogenase isoenzyme in the sera of pancreatitis patients seems to be caused by the release of this isoenzyme from damaged pancreatic cells.

Serum macrophage-colony stimulating factor levels in colorectal cancer patients correlate with lymph node metastasis and poor prognosis.

BACKGROUND: Elevated serum concentrations of macrophage-colony stimulating factor (M-CSF) have been found in a variety of malignant diseases. The aim of our study was to assess correlations between serum levels of M-CSF and clinicopathological features and survival rates in patients with colorectal cancer (CRC). PATIENTS/METHODS: M-CSF and the established tumor markers (carcinoembryonic antigen - CEA and carbohydrate antigen - CA 19-9) were investigated in the sera of 116 colorectal cancer patients and correlated with the clinical parameters of the disease and with the survival of patients. We compared M-CSF serum levels in CRC with colorectal adenoma patients. M-CSF was determined using enzyme-linked immunosorbent assay (ELISA). Tumor markers were measured by microparticle enzyme immunoassays (MEIA). RESULTS: CRC patients had significantly higher M-CSF and tumor markers levels compared to healthy controls and colorectal adenoma patients, with a significant association between M-CSF levels, disease stage and lymph node metastasis. Serum levels of M-CSF and CEA decreased significantly after radical resection of the tumor. Moreover, the multivariate analysis showed that the serum level of M-CSF in CRC patients was an independent prognostic factor. CONCLUSION: These findings suggest the potential clinical use of circulating M-CSF measurements, particularly in estimating prognosis for patients with CRC.

Connection between masticatory efficiency and pathomorphologic changes in gastric mucosa.

OBJECTIVE: The purpose of this investigation was to establish a connection between masticatory deficiency and pathomorphologic alterations of gastric mucosa in patients with dyspepsia. METHOD AND MATERIALS: In 40 dyspeptic, edentulous and partially dentate patients and in 40 dyspeptic control patients with good dental status, the Optosil masticatory function test was performed. Histopathologic changes of gastric mucosa and the severity of Helicobacter pylori infection were scored according to the updated Sydney Classification of Chronic Gastritis. RESULTS: The comminution of Optosil particles after increasing the number of chewing strokes was significantly impaired in edentulous and partially dentate patients, indicating masticatory deficiency in this group. This masticatory deficiency group was subdivided into groups with a lower (subgroup 1) and higher (subgroup 2) degree of masticatory deficiency according to median X50 in the Optosil test. The endoscopic appearance of gastric mucosa in masticatory deficiency patients and in the control group suggested chronic gastritis. Higher inflammatory and infection scores were noted in subgroup 2 than in the control group and subgroup 1, especially in the antral part of the stomach. The differences between the antral part and the body of the stomach were significant only in subgroup 2. CONCLUSIONS: Masticatory deficiency in patients with dyspepsia was connected with more severe chronic inflammatory changes and H. pylonri infection of gastric mucosa, especially in the antrum of the stomach. Higher values of inflammatory and infection scores in the subgroup with a higher degree of masticatory deficiency suggest its causal role in the promotion of gastritis and H. pylori infection.

[Assessment of selected tests in diagnostics of Helicobacter pylori infections]. / Ocena wybranych testów do rozpoznawania zakazenia Helicobacter pylori.

UNLABELLED: In the diagnostics of Helicobacter pylori infections the invasive and noninvasive methods are applied. In the epidemiological studies the measurement of antibodies of IgG class against H. pylori in the serum or the respiratory test is used. The aim of the study was comparative evaluation of diagnosing of H. pylori infection on the basis of the measurement of antibodies in the serum, HpFL antigens in stool and culture of biopsy specimens from the gastric mucous. MATERIAL AND METHODS: The study included 380 children aged 1-18 years drawn randomly for epidemiological analysis of H. pylori infection in Lower Silesia in the year 2001. The study was conducted in the year 2002. In all children the concentration of antibodies against H. pylon' of IgG class in the serum using the ELISA method as well as H. pylori antigen (HpFL) in stool were determined. In 66 children out of the whole group the measurements of antibodies using ELISA method and immunoblotting as well as HpFL test were compared to the results of H. pylori culture. Additionally the Hp Cag (+) strains were determined. RESULTS: The study demonstrated that in 10% of patients with negative results of IgG class antibodies against H. pylori measurement in the serum (below 24 U/ml) the HpFL test in stool was positive. The sensitivity of the test was 58.9%, specificity 90.0%. The correspondence of HpFL test with positive test for the antibodies in the serum was 90% for the antibodies concentration above 500 U/ml. Assuming that a definite test for the H. pylori infection is culture, the most accurate test for detection of the infection turned out to be the determination of the antigen in the stool and immunoblotting. The parallel increase of antibodies titre together with the increase of prevalence of infection with Hp Cag (+) strains was demonstrated. CONCLUSIONS: The results of HpFL test in stool samples are comparable to the culture, immunoblotting and antibodies concentration in the serum above 100 U/ml.

Contrast-enhanced, wide-band phase-inversion power Doppler imaging of hepatic focal nodular hyperplasia.

BACKGROUND/AIMS: To determine whether examination of hepatic focal nodular hyperplasia by wide-band, phase-inversion sonography offers any advantages over power and color Doppler sonography in the depiction of specific characteristics of these pathologies. METHODOLOGY: Twenty-six patients were examined. The presence of focal nodular hyperplasia was confirmed by ultrasound-guided biopsy, surgical resection, dynamic helical computed tomography or magnetic resonance. All patients, prior to enhanced sonography, had undergone B-mode gray-scale sonography, color Doppler, and power Doppler examinations. After injection of 2.5 g of Levovist intravenously, analysis of the contrast agent arrival was performed by wide-band, phase-inversion power Doppler sonography. RESULTS: The B-mode gray-scale sonography, color and power Doppler sonography were non-specific for focal nodular hyperplasia in 14 cases in our examination. However based on the wide-band, phase-inversion power Doppler sonography findings all patients with focal nodular hyperplasia were diagnosed. All typical anatomic features of focal nodular hyperplasia such as "star sign" or "spoke-wheel" pattern were clearly visible. In 3 cases, computed tomography and magnetic resonance imaging had failed to disclose pathology while phase-inversion sonographic images were completely suggestive which was later finally confirmed by histologic examination. CONCLUSIONS: Our data demonstrate the usefulness of wide-band, phase-inversion power Doppler sonography in the differential diagnosis of hepatic focal nodular hyperplasia by visualizing all characteristic anatomic details.

The effect of endothelin-1 receptor antagonists in acute experimental pancreatitis in the rats.

The relative role of endothelin-1 receptors, ET(A) and ET(B) blockade in acute pancreatitis (AP) remains controversial. The aim of the study was to compare the effect of nonselective ET(A/B) antagonist (LU 302872) and selective ET(A)antagonist (LU 302146) in severe taurocholate AP in rats. Male Wistar rats with AP were treated with increasing doses: 1, 5 or 10 mg/kg b.w. of antagonists i.p. at 0, 6, 12, 18 h after induction of AP. In 24 h survivors, free active trypsin (FAT) and total potential trypsin (TPT), chymotrypsin and lipase in 12,000 x g supernatants of the pancreases were assayed. The index of trypsinogen activation (% FAT/TPT) was elevated in untreated AP to 29.2 +/- 5.0 vs 5.4 +/- 0.9 in the control (p < 0.001). ET(A/B) antagonist at increasing doses, diminished this index to 9.8 +/- 2.7, 10.3 +/- 1.6 and 10.1 +/- 2.0 respectively (p < 0.005). ET(A) antagonist reduced % FAT/TPT ratio to 10.6 +/- 1.9 (p < 0.005), 13.4 +/- 0.5 (p < 0.001) and 10.2 +/- 2.4 (p < 0.005) at respective doses. Both antagonists to a similar degree reduced the histological scores of inflammation, hemorrhages and necrosis. The increase in chymotrypsin and lipase activities after 24 h was not significant. In conclusion, both nonselective ET(A/B) and selective ET(A) antagonists attenuated to similar degree the augmented trypsinogen activation and pancreatic injury in taurocholate acute experimental pancreatitis in rats. Endothelin-1 receptor antagonists could be beneficial in the course of acute pancreatitis by the attenuation of trypsinogen activation.

[Endoscopic treatment of gastroesophageal reflux disease--new possibilities]. / Leczenie endoskopowe choroby refluksowej przelyku--nowe mozliwosci.

Gastro-esophageal reflux disease (GERD) is one of the most important problems of gastroenterology at present. The symptoms of GERD have negative influence of patients' life on a daily basis. The principal aim of reflux disease treatment is to eliminate or alleviate the symptoms, to heal tissue damages and to reduce the frequency and duration of recurrences. Lifestyle and dietary modification are of only limited value in GERD treatment. Proton pump inhibitors (PPI) are the mainstay of GERD pharmacotherapy for both initial episode and long-term management. Surgical treatment is indicated in: complicated GERD, in patients who need high effective dose of medication, young patients who need lifelong PPI, patients with big hiatus hernia. Laparoscopic Nissen fundoplication has become the operation of choice. Nevertheless patients who have undergone fundoplication may experience adverse post operative complication. The useful alternatives in the management of GERD may indeed eventually prove the new endoscopic methods of minimally invasive treatment which are currently under thorough evaluation. The most promising methods of endoscopic treatment of GERD have been discussed: radiofrequency ablation (the Streett's procedure), endoscopic gastroplasty, endoscopic implantation of biopolymer hydrogel prosthesis.

[Therapeutic management of peptic ulcer bleeding]. / Postepowanie farmakologiczne w krwawieniach w chorobie wrzodowej zoladka i dwunastnicy.

Despite development of new diagnostic and therapeutic methods bleeding from peptic ulcer is still associated with high rate of complications and mortality. Apart from endoscopic therapy, pharmacological treatment is of great importance. Affecting platelet aggregation and fibrin formation low pH level of gastric juice impairs processes of coagulation. The fastest and most stable control of acid secretion is achieved by proton pump inhibitors. In the cases of active bleeding from peptic ulcer or signs of recent bleeding such as visible vessel or adhering clot, administration of high doses of proton pump inhibitors by continuous intravenous infusion significantly reduces bleeding recurrence rate. Among patients with Helicobacter pylori (H. pylori) infection, eradication of the bacteria after bleeding episode is mandatory.

[Ischemic heart disease and gastro-oesophageal reflux disease--simultaneous 24 monitoring of ECG and oesophageal pH]. / Choroba niedokrwienna serca a choroba refluksowa przelyku-ocena za pomoca jednoczasowego 24-godzinnego monitorowania EKG i pH w przelyku.

AIM: To determine the correlation between episodes of ischaemia in ECG recordings with pathologic gastro-esophageal reflux during simultaneous 24 hour monitoring of ECG and oesophageal pH. METHODS: Simultaneous 24 hour monitoring of ECG and oesophageal pH was performed in 30 patients (p) (26 M/4F, aged 39-74) with coronary artery disease of CCS class II-III, CAD was confirmed in coronary angiography. Analysis of the oesophageal pH was performed by using the Polygram programme (PW-version 2.04 Esophogram-version 2.01). ST depression > 1 mm and lasting at least 1 min was regarded as significant in ECG monitoring. Pathologic gastro-esophageal reflux was defined as a drop in pH < 4 lasting more than 5 min. Gastrooesophageal reflux disease (GERD) was diagnosed when a drop in pH < 4 lasted for more than 5% of the monitoring period. Gastro-oesophageal reflux dependent ST depression was defined as an ST depression that occurred during reflux episode and lasted up until 10 min from the end of the reflux. RESULTS: 26 patients (87%) had a total of 116 episodes of ST depression and 21 out of the 116 episodes (18%) were Gastro-oesophageal reflux time dependent. Fifteen patients (50%), had at least one episode of ST depression, depending on the time of reflux. Pathologic gastro-esophageal reflux was present in 25 patients (85%). In 14 patients (46.6%), the GERD pH criteria were fulfilled. In this group of patients, there was a significantly longer time of total ST depression (total ischaemic burden). CONCLUSIONS: 1. GERD is a frequent disease in patients with angiographically proven coronary artery disease. 2. Pathological gastroesophageal reflux can induce myocardial ischaemia, which can be determined by analysis of ST depression during 24 hour monitoring of ECG.

Seroprevalence of Helicobacter pylori infection in Polish children and adults depending on socioeconomic status and living conditions.

PURPOSE: Helicobacter pylori (H. pylori) is one of the causes of gastritis, peptic ulcer disease, gastric cancer and MALT-lymphoma. The frequency of H. pylori infection is different in various regions of the world and dependent on age, socioeconomic and hygiene status. The objective of this study was to assess seroprevalence and the associated socioeconomic and sociodemographic characteristics influencing H. pylori infection in children and adults in Polish population. MATERIAL/METHODS: In multicenter epidemiological studies, H. pylori infection occurrence was assessed in Poland in the years 2002 and 2003. The seroprevalence of H. pylori infection diagnosis was based on IgG anti-H. pylori antibodies concentration above 24 UI/ml, which was measured using ELISA test. The study included 6565 subjects: 3307 adults (50.37%) and 3258 children (49.63%). RESULTS: Positive result was observed in 3827 subjects (58.29%), i.e. 1043 children (32.01%) and 2784 adults (84.19%). H. pylori infection prevalence was greater in children of poor economic status, who were born in a rural area, lived in crowded houses with no running tap water and with toilet outside the house, and who did not observe hygiene rules. In adults, the factors predisposing to higher probability of being H. pylori infected included: being born in a rural area, having low family income and elementary education, smoking tobacco, drinking high proof alcohols as well as not observing of hygiene rules. CONCLUSIONS: Improvement of socioeconomic status, sanitary and hygienic conditions and the education of the society might decrease H. pylori infection prevalence in children and in adults.

The impact of Helicobacter pylori on EGF, EGF receptor, and the c-erb-B2 expression.

PURPOSE: Increased expression of epidermal growth factor (EGF), its receptor (EGFR), and c-erb-B2 protein, which is homological with the EGF receptor, in gastric mucosa, may play a role in gastric carcinogenesis. We assessed if the infection and eradication of Helicobacter pylori (H. pylori) affects the gastric expression of growth factors and serum gastrin concentrations. PATIENTS/METHODS: We examined immunohistochemically gastric EGF and both receptors' expression in: gastric cancer (GC; n=29), chronic gastritis with H. pylori infection (GHp+; n=40) before and after eradication and in patients without H. pylori infection (GHp-; n=42). RESULTS: Before the eradication therapy, gastric mucosal EGF and both receptor's expressions in GHp+ patients were increased compared to GHp- (p<0.05), but were similar to GC. After eradication, EGF and the receptor's expression significantly decreased in the gastric body. Both EGFR and c-erb-B2 expression in the antrum were still higher than in GHp- (p<0.05), and remained comparable to GC. CONCLUSIONS: In patients with H. pylori infection the gastric mucosal EGF, EGFR, and c-erb-B2 expressions are similar to those observed in gastric cancer. The persistence of the antral expression of receptors after eradication, at a level comparable to the gastric cancer group, suggests their eventual role in the progression of changes initiated by H. pylori toward carcinogenesis.

Alcohol dehydrogenase (ADH) isoenzyme activity in the sera of patients with Helicobacter pylori infection.

Human gastric mucosa contains three classes of alcohol dehydrogenase (ADH) isoenzymes: I, III, and IV. Various factors have been found to influence gastric ADH activity. One of them is Helicobacter pylori infection, which is associated with gastric mucosal injury and leads to a decrease in gastric ADH activity. The aim of the study was to assess the effect of H. pylori infection on the serum activity of ADH isoenzymes. Serum samples were taken from 35 patients with H. pylori infection and from 35 healthy subjects. For measurement of class I isoenzyme activity we employed the fluorometric method, with class-specific fluorogenic substrate (4-methoxy-1-naphthaldehyde). The activities of class III and IV ADH isoenzymes were measured by the photometric method with formaldehyde and with m-nitrobenzaldehyde as substrate, respectively. Total activity of ADH was measured by a photometric method with p-nitrosodimethylaniline. The total activities of ADH and class IV isoenzyme were significantly higher in sera of patients with H. pylori infection compared to healthy subjects. The serum activity of other tested isoenzymes of ADH did not differ significantly between infected and noninfected groups. We conclude that H. pylori infection of gastric mucosa is reflected in the serum by a significant increase in class IV and total ADH activity.

Helicobacter pylori and non-malignant diseases.

The prevalence of Helicobacter pylori-associated peptic ulcers, in particular duodenal ulcers, is decreasing following decreasing prevalence of H. pylori infection, while the frequency of non-steroidal anti-inflammatory drugs (NSAIDs)-induced and H. pylori-negative idiopathic ulcers is increasing. The incidence of bleeding ulcers has been stable during the last decades. Several putative H. pylori virulence genes, i.e., cag, vacA, babA, or dupA, as well as host-related genetic factors like IL-1beta and TNFalpha-gene polymorphism, have been proposed as risk factors for duodenal ulcer. H. pylori eradication may prevent NSAID complications, in particular, when it is performed before introduction of NSAIDs. There is a complex association between H. pylori and gastroesophageal reflux disease (GERD), and the impact of H. pylori eradication on the appearance of GERD symptoms depends on various host- and bacteria-related factors. Eradication of H. pylori in GERD is recommended in patients before instauration of a long-term PPI treatment to prevent the development of gastric atrophy. A small proportion (10%) of non-ulcer dyspepsia cases may be attributed to H. pylori and may benefit from eradication treatment. A test-and-treat strategy is more cost-effective than prompt endoscopy in the initial management of dyspepsia.

Activity of class I, II, III, and IV alcohol dehydrogenase isoenzymes in human gastric mucosa.

The gastric alcohol dehydrogenase (ADH) plays an important role in the "first pass" metabolism of ethanol. Human ADH exists in multiple forms, grouped into six classes and located in different tissues. In present study we investigated the activity of four classes (I, II, III, and IV) of alcohol dehydrogenase isoenzymes in the different parts of stomach (corpus and antrum) in patients with suspected gastric ulcer. The aim of the study was assess the particular role of different classes of ADH in the gastric dehydrogenase activity. For the measurement of the activity of class I and class II isoenzymes, we employed new fluorometric methods with specific substrates. The activity of class III alcohol dehydrogenase was measured by the photometric method with n-octanol and class IV with m-nitrobenzaldehyde as a substrate, respectively. All biopsy specimens were taken from less changed areas of the antrum and body of the stomach of 68 patients suspected of having gastric ulcer. It was found that ADH IV (gastric) activity was the highest (14.76 +/- 0.68 in the corpus of the stomach in men; and 7.61 +/- 0.68 in women, respectively). The activity of the ADH III isoenzyme was lower than that of ADH IV. The activities of class I and II ADH isoenzymes were barely detectable. All tested classes of ADH had higher activity in the corpus than in the antrum and in males than in females. In conclusion, the most important form of gastric ADH is isoenzyme of class IV, less important is the isoenzyme of class III. ADH classes I and II seem to have no role in the stomach.

[Drug sensitivity of Helicobacter pylori strains in children and young people from the region of Lódz]. / Lekowrazliwosc szczepów Helicobacter pylori u dzieci i mlodziezy regionu lódzkiego.

Combined therapy with a proton pump inhibitor and two antibiotics (metronidazole, clarithromycin and amoxicillin or tetracycline) is applied in the treatment of H. pylori infection. The effects of the treatment depend on drug sensitivity of H. pylori. Growing resistance to some of the applied antibiotics has been observed. The aim of the study was to assess drug sensitivity of Helicobacter pylori strains which were isolated from the gastric mucosa of children and young people living in the macroregion of Lódz. The study comprised 45 children aged between 5 and 18 years. Biopsy specimens were put on transport medium, incubated in microaerophilic environment, then identified. Drug sensitivity to metronidazole, clarithromycin, amoxicillin and tetracycline was assessed. We found resistance to metronidazole in 18% (8/45) children, resistance to clarithromycin in 16% (7/45) children and resistance to both antibiotics in 4% (2/45) children. No resistance to amoxicillin or tetracycline was noted.