Diagnostic accuracy of urine-based kits for detection of Helicobacter pylori antibody in children.

BACKGROUND: Rapid urine-HpAb is reported to be a reliable test of Helicobacter pylori infection in adults, but there are no data on the application of the test in children. The aim of this study was to evaluate the accuracy of a urine-based enzyme-linked immunosorbent assay (urine-HpELISA) and immunochromatography (rapid urine-HpAb) kit for anti-H. pylori immunoglobulin G antibody in children. We compared its sensitivity and specificity in reference to the (13) C-urea-breath test (UBT) and H. pylori stool antigen test (HpSA). METHODS: In total, 101 Japanese children without significant upper-abdominal symptoms were included (mean age, 7.1 years; range 2-15 years). Their sensitivity and specificity were evaluated in reference to the UBT and HpSA. RESULTS: Thirty-seven children were judged H. pylori-positive and 64 negative by the UBT and HpSA. No discrepancy in the results was observed between UBT and HpSA. Urine-HpELISA showed 91.9% sensitivity and 96.9% specificity with an accuracy of 95.0%. Rapid urine-HpAb showed 78.4% sensitivity and 100% specificity with an accuracy of 92.1%. Seven false negative results for rapid urine-HpAb were from children aged younger than 10 years, and their antibody titers of urine-HpELISA were lower than true positives. CONCLUSIONS: For the diagnosis of H. pylori infection in Japanese children, both tests are non-invasive, inexpensive, reliable and easy-to-perform methods giving satisfactory accuracy, although the sensitivity of the rapid urine-HpAb kit was inferior to that of the urine-HpELISA kit, especially in children aged younger than 10 years, showing relatively low titer of H. pylori antibody.

Assessment of vagotomy status with postprandial urinary alkaline tide.

AIM: This study was carried out to assess whether the postprandial urinary alkaline tide, as a marker for the completeness of vagotomy, is dependent on the nature of the test meal, whether it is affected by proton pump inhibitor therapy, and whether it is reliable. METHODS: The postprandial urinary alkaline tide (PUAT) pattern was prospectively assessed in three different study groups and one control group of healthy volunteers. The three study groups were as follows; A (n = 20) i.e. the Proton Pump Inhibitor (PPI) Group; B (n = 25) i.e. the Truncal Vagotomy (TV) Group; and C (n = 5) i.e. the Recurrent Ulcer (RU) Group. Urinary pH was measured by a pocket digital pH meter. RESULTS: Postprandial urinary alkaline tide in the control group was significantly higher compared to the fasting levels. Liquid diet did not elicit a significant urinary alkaline tide response. There was a statistically significant fall in both fasting urinary pH (5.34 +/- 0.70 vs. 4.80 +/- 0.61, p = 0.031) and the postprandial alkaline tide (6.99 +/- 0.79 vs. 4.94 +/- 0.63, p = 0.0001) after taking proton pump inhibitors. In the truncal vagotomy and gastrojejunostomy group it was found that there was a significant fall in both the mean fasting (5.28 +/- 0.58, vs. 4.92 +/- 0.66, p = 0.032) and the postprandial urinary pH (6.29 +/- 0.92 vs. 5.09 +/- 0.73, p = 0.0001) following surgery. CONCLUSION: This study establishes that simple measurement of the urinary pH before and after a standard test meal can be used as an accurate routine test for the completion of vagotomy. It also showed that proton pump inhibitors abolish the alkaline tide and therefore must be discontinued before measuring the alkaline tide. Liquid test meal was not effective in eliciting an alkaline tide as compared to a solid meal.

Low sodium excretion in SIADH patients with low diuresis.

UNLABELLED: It is well known that during low diuresis or low effective circulating volume, salt excretion is low. The aim of this study was to find out whether salt excretion, expressed as either urinary sodium concentration (UNa) or fractional sodium excretion (FENa), and the combined use of FENa and fractional urea excretion (FEurea) still differentiate between hyponatremic SIADH and hyponatremic salt depletion (SD) patients when diuresis is low. The relationships between UNa, FENa and diuresis, indirectly estimated by the urinary to plasma creatinine ratio (U/P creat), were studied in 42 hyponatremic SIADH patients, 21 hyponatremic SD patients and 66 normonatremic controls (CO) of similar age and sex ratio. There was no significant relationship between UNa and U/P creat either in SIADH or in SD or CO patients. FENa and U/P creat were inversely correlated, both in CO (r = -0.72; p < 0.001) and in SIADH (r = -0.68; p < 0.001). SIADH and SD patients can be fairly well differentiated from one another using FENa and U/P creat. Even with high U/P creat values, SIADH patients, despite a sharp decrease in their FENa values, presented still higher FENa values than SD patients did (mean FENa = 0.3 +/- 0.2% in SIADH and 0.1 +/- 0.04% in SD; p < 0.05). However, FENa values of SIADH patients with low diuresis (mean FENa = 0.3 +/- 0.2% for a mean U/P creat = 191 +/- 40) are indistinguishable from those of SD patients with normal urine volumes (mean FENa = 0.2 +/- 0.2% for a mean U/P creat = 92 +/- 30). The combined use of FENa and FEurea remains a reliable way to discriminate SD patients and SIADH patients, as far as the differential limit value for FENa is narrowed to a value of 0.15%, for hyponatremic patients with U/P creat >140. CONCLUSION: In SIADH, FENa values are lower than 0.5%, as soon as U/P creat exceeds a value of 180. In SD patients with U/P creat values exceeding 140, FENa is lower than 0.15% and FEurea lower than 45%.

[Melatonin: ulcer disease and seasons of the year]. / Melatonin: iazvennaia bolezn' i sezony.

Melatonin produces a great variety of effects in human organism and plays an essential role in normal function of the body. This explains growing interest of medical researchers to this substance. The paper provides the results of 3-year studies of seasonal rhythm of melatonin production in patients with duodenal ulcer. Acute disorders of circadian and seasonal melatonin production in summer and autumn were discovered in patients with duodenal ulcer. These findings suggest involvement of abnormal melatonin production in pathological mechanisms of autumn exacerbations of duodenal ulcer.

Melatonin production in patients with duodenal ulcer.

UNLABELLED: OBJECTIVES. This work was designed to study melatonin (M) production levels in duodenal ulcer (DU) patients in the exacerbation and remission stages and in DU patients with a different course of DU in the exacerbation and remission stages. METHODS: DU patients (15 men aged 20 to 45, mean age 34,2 +/- 1,1 years) were studied. The control group included 11 healthy volunteers (men aged 20-45, mean age 32,5 +/- 1,4 years). M was measured by RIA-method using H(3)-labeled M in daily urine collected at 3-hour intervals (8 portions per day). Mathematical processing was carried out using ANOVA, Student's t-test, and cosinor analysis. Differences at p< or = 0,05 were considered to be significant. RESULTS: A strong disturbance of M secretion in DU patients both in the exacerbation and remission stages and a direct correlation between the degree of M production disturbance and severity of clinical course of DU were revealed. CONCLUSION: The obtained results suggest that circadian rhythms of M production are altered in DU patients. M was supposed to be involved in the pathogenesis of DU.

Abolition of postprandial alkaline tide in arterialized venous blood of duodenal ulcer patients with cimetidine and after vagotomy.

OBJECTIVE: Alkaline tide is the observed alkalinization of blood and urine after stimulation of gastric acid secretion. In previous studies, we found good correlation between gastric acid output and alkaline tide in arterialized venous blood. METHODS: In the present study, the alkaline tide phenomenon was further investigated in 26 duodenal ulcer patients (seven post-vagotomy) after a test meal, before and after cimetidine pretreatment. RESULTS: Alkaline tide was demonstrated in everyone of the 19 duodenal ulcer nonvagotomized patients but in only two of the seven vagotomized patients; base excess mean rise of 1.05 +/- 0.14 mEq/L/45 min versus -.07 +/- 0.23 mEq/L/45 min (mean +/- SE, p < 0.001). Decrease in alkaline tide after cimetidine was demonstrated in the nonvagotomized group: 1.05 +/- 0.14 mEq/45 min versus -0.03 +/- 0.16 mEq/45 min, before and after cimetidine, respectively (mean +/- SE, p < 0.001). Urinary alkaline tide was demonstrated in only 4/19 and 2/19 of the first group (with and without cimetidine, respectively) and in only 1/7 of the post-vagotomy group. CONCLUSIONS: Our results suggest an association between gastric acid secretion and blood alkaline tide, because both are inhibited by cimetidine or vagotomy.

The kinetics of aluminium-containing antacid absorption in man.

The kinetics of aluminium absorption were determined in patients with duodenal ulcer and in 2 normal males after taking the antacid Tisacid (Biogal, Hungary). A peak serum aluminium of 54.5 micrograms/l was reached at 30 min, returning to the initial value of 6.8 micrograms/l at 3 h after the oral intake. Urinary but not serum aluminium increased in parallel to the amount of drug taken. The serum Al values are considerably influenced by the time of sampling. Owing to the rapid absorption and excretion of aluminium, there appears to be no danger of aluminium deposits in the tissues or of neurological alterations, provided renal function is normal.

[B group vitamin metabolism in duodenal ulcer disease, hypertension, and ischemic heart disease]. / Obmen vitaminov gruppy B pri iazvennoi bolezni dvenadtsatiperstnoi kishki, gipertonicheskoi bolezni i ishemicheskoi bolezni serdtsa.

No differences were found in the rate of metabolism of vitamins B1, B2, B6 and niacin either in healthy persons or in patients with duodenal ulcer, hypertension of the 2nd degree and with ischemic heart disease as shown by excretion of riboflavin, 4-pyridoxylic acid, 1-methyl nicotinamide and thiamin with urine which correlated with concentration of these vitamins and their coenzyme forms in blood plasma and erythrocytes. Dependence of these vitamins excretion with urine on their concentration in blood and the vitamins content in food appear to demonstrate similar consumption of vitamins B in the persons studied; at the same time, evaluation of the vitamins consumption in the patients with these forms of pathology should be performed using the criteria suitable for healthy persons. Dissimilar rates of metabolism of these vitamins described in literature might be related to differences in nutrition as well as to the use of nonspecific techniques for estimation of the vitamins. Besides, initial consumption of vitamin B2 was not sometimes considered, but deficiency in riboflavin caused considerable impairments of vitamin B6 and niacin metabolism.

Factor de crecimiento epidérmico en orina y pepsinogeno I serico en pacientes ulcerosos duodenales / Urinary epidermic growth factor and serum pepsinogen I in duodenal ulcer patients

Se determinaron los valores urinarios del Factor de Crecimiento Epidérmico (FCE) absolutos y corregidos por la excreción de creatinina en 23 ulcerosos duodenales y se compararon con un grupo control. En los pacientes se dosificaron valores basales de Pepsinógeno I sérico. Los valores absolutos de FCE urinario de los ulcerosos fueron más bajos que los controles, pero tal diferencia ni la de FCE corregido por la excreción urinaria de creatinina fueron estadísticamente significativas (p > 0,05). La excreción absoluta de FCE de los ulcerosos varones fue mayor que en las damas (p<0,05), pero al establecer la relación FCE/Creatinina, la diferencia desapareció. No hubo correlación entre FCE y Pepsinógeno I, fue inversa con la edad y positiva con la excreción de creatinina. Varios mecanismos se plantean para explicar la normalidad urinaria del FCE en estos pacientes. La importancia creciente que se da al FCE en enfermedad ulcerosa y ulteriores investigaciones, son analizadas

[Level of certain carbohydrate components in blood serum and urine of patients stomach and duodenal ulcer patients in the late post-vagotomy period]. / Soderzhanie nekotorykh uglevodnykh komponentov v syvorotke krovi i moche bol'nykh v otdalennye sroki posle vagotomii pri iazvennoi bolezni zheludka i dvenadtsatiperstnoi kishki.

Estimation of protein-bound hexoses, fucose and sialic acids in the blood and urine of 64 patients with gastroduodenal ulcers within later periods after various types of gastric vagotomy showed that the denervation inhibited the protective barrier of gastric and duodenal mucosal membrane. Protective functions of gastroduodenal mucosal membrane were most distinctly inhibited after selective proximal vagotomy which may be responsible for higher amounts of recurrences of ulcerous disease after this type of vagotomy than other types of denervation.

[Urinary epidermal growth factor and serum pepsinogen I in patients with duodenal ulcers]. / Factor de crecimiento epidérmico en orina y pepsinógeno I sérico en pacientes ulcerosos duodenales.

Absolute and corrected by creatinine excretion urinary Epidermal Growth Factor (EGF) values were determined in 23 duodenal ulcer patients and compared to a control group. Basal serum pepsinogen I levels were measured in the patient group. Absolute urinary EGF values in patients were lower than in control group, such difference however, as such of EGF corrected by urinary creatinine excretion were not statistically significant (p > 0.05). Absolute urinary EGF excretion in male patients was higher than in female patients (p < 0.05), but after establishing the ratio EGF/Creatinine, the difference disappeared. There was no correlation between EGF and Pepsinogen I, it was inverse with age and positive with creatinine excretion. Some mechanisms are considered to explain the urinary EGF normality in these patients. The increasing importance given to EGF in ulcerous diseases and further trends in research are analyzed.

[The determination of the concentration of antithrombin III in the urine]. / Opredelenie kontsentratsii antitrombina III v moche.

The authors developed the special enzyme immunoassay technique for the detection of the urinary antitrombin III (AT-III) levels. Sensitivity of the method was 7.8 ng/ml. The study lasted for 2 hrs. The levels of AT-III were studied in the circadian human urine in health, in physiological and nephropathy-complicated pregnancy, as well as in patients with gastroduodenal ulcer-induced bleeding. There was a 34.1-fold increase in the urinary AT-III levels in pregnant females with Stages II-III nephropathy and a 17.3-fold increase in those who sustained the resection of the stomach, which could be explained by proteinuria and abnormal resorption of AT-III in the proximal tubules of the kidney.

Urine acid output as a test of completeness of vagotomy.

Peak acid output in response to sham feeding and changes in urine acid output 2 and 3 hours after a test meal have been measured in 20 normal volunteers, 17 asymptomatic patients after vagotomy, six patients with recurrent duodenal ulcer after vagotomy and ten normal subjects given a 48-h course of ranitidine, 150 mg 12-hourly. Gastric peak acid output in normal volunteers ranged from 6.9 to 22.1 mmol/h. All asymptomatic patients after vagotomy had a peak acid output less than 7 mmol/h, consistent with complete vagotomy. Five patients with recurrent ulcer had a peak acid output greater than 8 mmol/h, suggesting an incomplete vagotomy. Urine acid output after a test meal, expressed as the change from the basal rate of acid output, was always in a negative direction in normal subjects (fall in acid output = postprandial alkaline tide). This change was abolished in patients with complete vagotomy, in whom urine acid output increased after a meal. In five patients with incomplete vagotomy (and one other with recurrent ulcer and unknown vagal status) the urine acid output changed in a negative direction after a test meal. The relationship of urine acid output to gastric secretion was confirmed by the abolition of the postprandial alkaline tide in normal subjects given ranitidine. The results in patients with incomplete vagotomy did not overlap with those from patients with complete vagotomy. This suggests that this test could be used for the routine postoperative assessment of completeness of vagotomy.

[Elimination of glycosaminoglycans in duodenal peptic ulcer and problems of its pathogenesis]. / Vydelenie glikozaminoglikanov pri iazvennoi bolezni dvenadtsatiperstnoi kishki i nekotorye voprosy ee patogeneza.

Changes in the excretion and composition of proteoglycans specific for duodenal ulcer were studied in 50 patients with duodenal ulcer, 30 patients with gastric ulcer, 30 patients with chronic endogenous gastroduodenitis and in 35 healthy persons. In all the examinees proteoglycans were isolated from daily urine, their carbohydrate components--glycosaminoglycans (GAG)--were separated and divided into fractions (keratan sulfate, hyaluronic acid, heparan sulfate, chondroitin sulfate-4, chondroitin sulfate-6, dermatan sulfate, and heparin) by column chromatography on unmodified cellulose. It has been established that only peptic ulcer is characterized by disorders in GAG excretion differing in the period of exacerbation and remission. Changes in the composition of proteoglycans excreted with urine resulted probably from a deficiency of chondroitin sulfate-6 in patients with chronic duodenal ulcer. The deficiency was more marked during exacerbation but did not disappear in the period of remission of duodenal ulcer either.

[Excretion of various glycosaminoglycans in patients with chronic duodenal ulcer]. / Vydelenie razlichnykh glikozaminoglikanov u bol'nykh khronicheskoi duodenal'noi iazvoi.

Excretion of individual glycosaminoglycans (GAG's) with urine was studied in patients with chronic duodenal ulcer. 31 patient with acute manifestations of the duodenal ulcer, 24 patients within the period of remission as well as 29 practically healthy persons were studied. Column chromatography on cellulose was used for separation of a mixture containing keratan sulfate, hyaluronic acid, heparan sulfate, chondroitin-4 and -6-sulfates, dermatan sulfate and heparin. During the acute period of duodenal ulcer daily excretion of all the individual GAG's with urine was decreased (especially distinct for the fraction of chondroitin-6-sulfate) as compared with excretion of these carbohydrates in healthy persons. The level of GAG excretion was increased distinctly, exceeding the values found in healthy persons, during the remission. Excretion of chondroitin-6-sulfate and keratan sulfate was markedly increased in these cases.