Comparison of three methods for gastrointestinal nematode diagnosis determination in grazing dairy cattle in relation to milk production.

Development of resistance to anthelmintic drugs has motivated the search for diagnostic methods to identify animals for targeted selective treatments. We compared three methods for the diagnosis of nematode infection in relation to milk production in a fully grazing dairy herd of 150 cows in the humid Pampa (Argentina). Animals had feces, blood and milk sampled during the first postpartum month for EPG, pepsinogen and anti-Ostertagia antibody determination, respectively. With the results obtained two groups of cows, divided in high and low parasite burden, were conformed for each method, and milk production was then compared between groups. When cows were separated by the EPG method (EPG=0 (N=106) vs. EPG>0 (N=44)) a difference of nearly 800 l of milk per cow per lactation was found (P<0.05). On the other hand, milk production between groups separated by Pepsinogen (mUtyr ≤ 1000 vs. mUtyr > 1000) or by anti-Ostertagia (ODR ≤ 0.5 vs. ODR > 0.5) results did not differ. Interestingly, proportion of cows in each group differed between methods (P<0.0001), and the anti-Ostertagia method yielded significantly more cows in the high index group compared to results using the EPG or Pepsinogen method. No correlations were found between parasite indexes determined by the different methods. High parasite burden estimation found may be ascribed to the production system, fully grazing all year round, and to the sampling time, at the beginning of lactation with cows in negative energy balance and depressed immunity. The fact that the cows were born and reared outside, on pasture with continuous nematode larvae exposure, may also account for the results obtained. In conclusion, EPG counting during the first postpartum month may be a useful tool for the diagnosis of production impairment induced by high nematode burden in adult grazing dairy cows. The anthelmintic treatment of only the EPG-positive recently calved cows would improve milk production, while reducing selective pressure on nematode population for the development of resistance.

[Detection of gastric preneoplastic lesions with serum levels of pepsinogen in Chilean subjects]. / Detección de lesiones preneoplásicas gástricas mediante niveles séricos de pepsinógeno en población chilena.

BACKGROUND: Gastric cancer has a direct relation with chronic atrophic gastritis (AG) and intestinal metaplasia (IM), considered as preneoplastic lesions. Determination of serum pepsinogen llevéis (PGI) and pepsinogen I / pepsinogen II ratio (PGI/PGII) can detect this conditions; achieving 70-90% of gastric cancer detection in early stages. AIM: To determine the cut-off values for serum PGI and PGI/PGII in Chilean subjects, for the detection of gastric preneoplastic lesions, establishing their sensitivity, specificity, positive (PPV) and negative (NPV) predictive values. PATIENTS AND METHODS: Prospective study of patients subjected to upper gastrointestinal endoscopy and determination of serum pepsinogen levels. The presence and severity of preneoplastic lesions were compared with serum levels of PGI and PGI/PGII. RESULTS: A total of 56 men and 44 women were studied, with a mean age of 43 (14-77) years. There was a significant association (p <0.001) of PGI and PGI/PGII with AG and IM. We obtained a cut-off value of 2.3 for PGI/PGII (sensitivity =70%>, specificity =92%>, PPV =60%>, NPV =95%) and 36 ng/ml for PGI (sensitivity =62%o specificity =64%o, PPV =20%o, NPV =91%), for detection of moderate to severe AG. No patient with normal mucosa had a PGI <20 ng/ml. The combined criteria of PGI/II < or = 2.3 and/or PGI < or 20 ng/ml, obtained a sensitivity of 85%o, specificity of 92%>, PPV of 65%o, and NPV of 97%o. CONCLUSIONS: We confirmed a strict relation ofPGIand PGI/PGIIwith the presence of preneoplastic gastric lesions in Chilean patients.

Noninvasive versus histologic detection of gastric atrophy in a Hispanic population in North America.

BACKGROUND & AIMS: Cancer risk is directly correlated with the severity and extent of mucosal atrophy, making identification of atrophy a goal in cancer prevention programs. The aim of this study was to compare targeted histology with noninvasive testing for the identification of antral and/or corpus atrophy in North America. METHODS: In a cross-sectional study of a random sample of households, 8 gastric biopsy specimens were obtained from defined locations in the antrum and corpus. Biopsies were scored for the presence of Helicobacter pylori and gastric atrophy (defined as loss of normal glandular components). Atrophy was scored by using the Sydney system and a system based on the number and location of corpus biopsies with atrophy. Patients' sera were examined for pepsinogen I, pepsinogen II, and gastrin-17 (fasting and stimulated). RESULTS: One hundred eighty volunteers, approximately 30 per age group and ranging in age from 18-82 years, participated. There were 76 men. The overall weighted prevalence of a corpus atrophy was 4.7% (95% confidence interval, 2.3-7.0). There was a significant inverse relationship between the grade of corpus atrophy and the pepsinogen I/pepsinogen II ratio (R = -0.31, P < .01). We failed to confirm the usefulness of the proposed algorithm by using gastrin-17, H. pylori serology, and serum pepsinogens to categorize the gastric histology. The Sydney system underestimated the prevalence of corpus atrophy by approximately 25%. CONCLUSION: Noninvasive testing is both possible and practical by using pepsinogen assays for the identification of the precancerous condition of moderate to severe corpus atrophy in North American Hispanic patients.

Lifestyle factors associated with atrophic gastritis among Helicobacter pylori-seropositive Japanese-Brazilians in São Paulo.

BACKGROUND: Studies of lifestyle factors related to gastric atrophy development in Helicobacter pylori-infected individuals are limited. The present cross-sectional study aimed to examine the associations between lifestyle factors and serum pepsinogens (PGs) among anti- H. pylori antibody-seropositive Japanese in Brazil, where gastric cancer mortality was reported to be as high as in Japanese in Japan, and seropositive individuals were still frequently detected. METHODS: The subjects were 291 seropositive individuals (129 males and 162 females; age, 30 to 69 years) out of 656 Japanese-Brazilian volunteers in São Paulo city. Information on lifestyle factors was obtained using a self-administered questionnaire. Atrophic gastritis was defined as a PG1 serum level less than 70 ng/ml and PG1/PG2 ratio less than 3. RESULTS: The prevalence of atrophic gastritis was 31.9% (95% confidence intervals, 26.6%-37.6%). The proportion of subjects with atrophic gastritis increased with age, but there were no significantly marked differences in the proportions of subjects with atrophic gastritis among the three generations studied (first generation [Issei], second generation [Nisei], and third generation [Sansei]) for any 10-year age group. The associations with smoking and alcohol drinking were not significant. Length of education was inversely associated with gastric atrophy, while infrequent rice intake was preventive; the odds ratio relative to everyday rice intake was 0.13 (95% confidence intervals, 0.39-0.46) on multivariate analysis. CONCLUSIONS: The present study demonstrated that frequent rice intake was a risk factor for atrophic gastritis among the H. pylori-infected Japanese-Brazilians, suggesting that diet including rice plays a role in the step from H. pylori infection to gastric atrophy.

Evaluacion de la concentracion serica de pepsinogeno como metodo de tamizaje para gastritis atrofica y cancer gastrico / Evaluation of serum concentration of pepsinogen as screening for athropic gastritis and gastric cancer

El cáncer gástrico en Colombia es un problema de salud pública por su alta incidencia y su diagnóstico tardío, con un porcentaje de cáncer temprano menor de 5 por ciento. Por estas razones, es imprescindible constituir un programa de tamizaje para cáncer gástrico que sea sensible, costo-efectivo y tolerable por los pacientes. El pepsinógeno I y el II han ido sustituyendo en el Japón al método de tamizaje con fluoroscopia ya que, como ha sido demostrado por varios autores, tiene una tasa de detección de cáncer gástrico de 0,168 por ciento comparado con el 0,066 por ciento de la fluoroscopia. Con esto en mente, decidimos evaluar el uso del pepsinógeno I para detectar gastritis crónica atrofia y cáncer gástrico. Para esto se tomaron dos poblaciones: 66 pacientes con cáncer gástrico y 110 tomados de la población general; a todos se les tomó muestra para pepsinógeno I y anticuerpos para Helicobacter pylori (IgG e IgA), con endoscopio y biopsia posterior. Se construyó una curva ROC para definir el mejor punto de corte para el pepsinógeno I, encontrándose que el mejor punto era un valor < 150 ng/ml con una sensibilidad de 84,3 por ciento y una especificidad de 71,3 por ciento. Podemos entonces concluir que el uso de pepsinógeno I es un buen método para detectar gastritis crónica atrófica y cáncer gástrico, y que se debería asociar la determinación del pepsinógeno II en nuestra población por la alta prevalencia de infección por H. pylori que en nuestro estudio fue de 97 por ciento

Site of peptic ulcer. comparison of hydrochloric acid output, pepsinogen and gastrin serum levels.

BACKGROUND/AIMS: Basal (BAO) and maximum (PAO) hydrochloric acid output after Histalog stimulation, basal pepsinogen (SPL-B), at 60 (SPL-60) and at 90 minutes (SPL-90), and basal gastrin (BG) levels were measured and compared in different gastric (GU) and duodenal (DU) ulcer sites. MATERIAL AND METHODS: Fifty nine patients with peptic ulcer were grouped according to Johnson's classification for gastric ulcers: type I (15), type II (16) type III (12) GU and (16) DU. Fifteen normal subjects were studied as controls. RESULTS: The BAO was greater in the DU than in the control or GU groups. No significant difference was noted in the production of hydrochloric acid after stimulation with Histalog. The SPL-B, at 60 and at 90 minutes was higher in type II GU than in the DU group and controls. The SPL-60 was higher in type II GU patients than in type III GU. Basal gastrin was higher in group DU and types II and III GU compared to the type I GU patients and controls. CONCLUSION: The topographic criteria for differentiating peptic ulcers has low discrimination capacity based on comparison of mean values of HCl acid production, pepsinogen and gastrin serum levels both basal and after stimulation with Histalog due to heterogeneity of these variables in group studies. In these studies, peptic ulcers from different sites should not be grouped as distinct entities except for type II gastric ulcers.

Determinants of plasma pepsinogen levels in a population at high risk for stomach cancer in Venezuela.

Determinants of plasma pepsinogens (PG) levels were studied in 1365 participants in a chemoprevention trial for gastric pre-cancerous lesions being conducted in Venezuela. Gastric biopsies, plasma samples and information on smoking and dietary habits were obtained at baseline examination. Both PG-I and PG-II levels increased progressively with the level of Helicobacter pylori infection in gastric biopsies, resulting in no clear trend in the I/II ratio. Instead, there was a progressive decrease in the I/II ratio with increasing degrees of infiltration of polynuclear cells and monocytes, atrophy, intestinal metaplasia and the stage of pre-cancerous lesions. The mean I/II ratios for atrophic gastritis or more advanced lesions were less than 4.0. When subjects with the I/II ratio 4 or higher were used as controls, severe reduction in the I/II ratio (< 2.0) was inversely associated with tobacco consumption. This may be due to a pharmacological effect of nicotine. The severe reduction of I/II ratio was also inversely associated with fresh fruit consumption. In addition, a decreased I/II ratio was positively associated with rice/pasta and arepas (tortilla made from corn) consumption and inversely associated with plantain consumption. Possible effects of vitamins and starchy food on the development of atrophic gastritis need to be studied further.

Comparative effects of nematode infection on Bos taurus and Bos indicus crossbred calves grazing on Argentina's Western Pampas.

Breed differences in resistance or tolerance to naturally acquired gastrointestinal nematodes were compared between Aberdeen Angus (AA) and Santa Gertrudis (SG) weaned steer calves grazing in a temperate environment. Within breeds, one half of the calves was untreated: AAU (n = 17) and SGU (n = 18) while the other half was treated with moxidectin monthly: AAT (n = 14) and SGT (n = 14). All calves were grazed on the same contaminated pasture from autumn to winter, when each group was separated to uninfected paddocks for the remaining period of the study. Faecal egg counts, plasma pepsinogen levels (PPL), herbage larval counts and liveweight (LW) were recorded monthly. Egg counts and PPL of AAU and SGU increased from autumn to early winter when calves showed heavy parasitism (mainly Trichostrongylus axei) and severely sick calves needed emergency treatment. On the clean paddocks, parasitological parameters progressively decreased. Late winter egg counts were higher (P < 0.05) in SGU than in AAU. PPL of SGU were higher than AAU ones, but no significant differences were detected. Larval differential counts of SGU showed fewer Cooperia (P < 0.08) and higher T. axei (P < 0.002) proportions than those of AAU. Numbers of severely sick and dead SGU calves (61%) were greater (P < 0.01) than those numbers of AAU calves (17.5%). Cumulative LW gains differences within SG breed were higher (P < 0.0001) than those differences within AA breed (P < 0.003). LW gains of AAU during autumn-winter period were greater (P < 0.002) than those of SGU.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum gastrin, pepsinogens, parietal cell and Helicobacter pylori antibodies in patients with gastric polyps.

OBJECTIVES: To determine serum concentration of gastrin and pepsinogens (PGs) as markers for the gastric mucosal status and to elucidate the prevalence of serum Helicobacter pylori (H pylori) IgG antibodies and parietal cell autoantibodies (PCAs) in patients with gastric polyps. METHODS: The subjects in this study were composed of 36 patients with fundic glandular polyps (FGP), 25 patients with foveolar hyperplastic polyps (FHP), and 27 asymptomatic healthy volunteers (controls). Serum concentrations of gastrin and PGs were determined by radioinmmunoassay. H. pylori IgG antibodies were measured through an enzyme-linked immunosorbent assay. PCAs were detected by an indirect immunofluorescence technique using cryostat sections of rat gastric mucosa. RESULTS: There were no significant differences between FGP patients and controls in serum concentrations of gastrin, PG I and PG II. FHP patients showed significantly higher serum gastrin, lower PG I, higher PG II levels and, as a consequence, far lower PG I/PG II ratio compared with controls. The prevalence of H pylori infection was much higher in FHP patients (84.0%), whereas lower in FGP patients (19.44%) than that in controls (40.7%) was positive in 24.0% of FHP patients, 2.78% of FGP patients and 4% of controls. CONCLUSIONS: These results suggest that FHP often develops in a gastric mucosa associated with H pylori infection, while FGP does not appear to be related to H pylori infection.

[HLA, blood group, secretory factor, pepsinogen I, and Helicobacter pylori in duodenal ulcer patients]. / HLA, grupo sanguíneo, factor secretor, pepsinógeno I y Helicobacter pylori en ulcerosos duodenales.

Duodenal ulcer is a multifactorial entity where a genetic predisposition and extrinsic elements seem to concur in its origin. A series of genetic and extrinsic markers were determined in 50 patients with duodenal ulcer and 50 controls matched by age, sex and socioeconomical status. HLA antigens dit not have significant differences. Blood group O Rh+ was predominant (p < 0.01). Secretor status of antigen HBO in saliva was positive in 70% of patients (p < 0.001). Serum Pepsinogen I was increased in 85% of cases (p < 0.001). Immunoglobulin G anti H. pylori was positive in 62% of ulcerous (p < 0.001). The highest sensibility and negative predictive value was represented by increased serum pepsinogen levels (85%); the highest specificity and positive predictive value was to Ig G anti H. pylori (90 and 86%). These results affirm the polygenic character of the duodenal ulcer disease.

Gastric chief cell mass in duodenal ulcer.

Chief cell mass and serum Pepsinogen I were calculated in 25 duodenal ulcer patients and in 40 healthy controls. Comparisons were also made with parietal cell mass and the stimulated acid secretion. Chief cell mass was expressed bay a Zymogenous Index (ZI) obtained by multiplying the number of chief cells per mm2 for the thickness of the glandular layer. The analysis of the data shows a significant decrease of ZI in duodenal ulcer patients in comparison with controls. The grouping of the subjects according to the age (over and under fifty years), confirms that ZI decreases significantly in duodenal ulcer groups in relation with the respective groups of control. In case of duodenal ulcer with fundic superficial gastritis no behavioural changes of ZI are observed in comparison to those affected by duodenal ulcer with normal fundic mucosa. The serum Pepsinogen I significantly increases in duodenal ulcer patients in comparison to the controls, either in the subjects over and under fifty. In the group of duodenal ulcer patients with superficial fundic gastritis a significant increase of serum Pepsinogen I can be pointed out in comparison to the ulcer patients with normal fundic mucosa. The grouping of the patients on the basis of hyperparietalism and normoparietalism has shown in the former group hypozymogenism and in the latter normozymogenism. Finally, no correlation has emerged between Zymogenous Index and serum Pepsinogen I.

[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.

Antibodies to Helicobacter pylori and pepsinogen levels in children from Costa Rica: comparison of two areas with different risks for stomach cancer.

In children and adolescents from two areas of Costa Rica with contrasting gastric cancer risks, two factors suspected to be linked to the natural history of the disease were tested: serum antibodies to Helicobacter pylori and serum pepsinogen levels. One hundred fifty-five subjects from the high-risk area of Turrubares were compared to 127 from the low-risk area of Hojancha. No significant differences were found in the prevalence of IgG or IgA antibodies to Helicobacter pylori between the two regions. The prevalence of IgG was 65.8% in the high-risk area and 72.4 in the low-risk area, and that of IgA was 43% in both areas. The levels of pepsinogen, especially pepsinogen C, were significantly elevated in subjects with H. pylori antibodies in their serum. The mean levels of pepsinogen C in those negative, positive, and strong positive for H. pylori antibodies were 8.7, 14.3, and 21.1 ng/ml. These findings suggest that H. pylori-associated gastritis, predominantly of antral localization, is very prevalent in Costa Rican children and adolescents. Such gastritis might be associated with a high prevalence of intestinal metaplasia and a high gastric cancer risk in the inland, but not the coastal rural populations. H. pylori may therefore be an insufficient cause whose role in gastric carcinogenesis is contingent upon the presence of other factors.

Proximal gastric vagotomy. A comparative study between the standard technique and the extended technique associated with denervation of the greater curvature.

Forty-six patients in the postoperative period of proximal gastric vagotomy (PGV) for duodenal ulcer (DU) were studied comparatively to verify whether the dividing of the gastroepiploic nerves (Rosati's maneuver) can reduce or not the occurrence of recurrent ulcer as it was proposed. Twenty-one patients who underwent PGV associated with Rosati's maneuver (PGV-R) were compared to 25 after standard PGV (PGV-S), according to several criteria: (1) clinical evaluation; (2) pre and postoperative basal and pentagastrin-stimulated gastric acidity; (3) postoperative basal and pentagastrin-stimulated serum pepsinogen; (4) postoperative basal and sham feeding-stimulated serum gastrin; (5) postoperative endoscopy; (6) endoscopic Congo red test. Both groups were similar (P greater than 0.05) as to age, sex, levels of preoperative gastric acidity and had a 24.4 month average follow-up (12 to 58 months). There has been no significant difference between the techniques studied as to clinical, secretory, morphological or hormonal gastric tests, although PGV-R proved more effective in reducing basal gastric acidity than PGV-S (P less than 0.05). We concluded that Rosati's maneuver does not improve the results obtained with PGV, although it provided greater reduction of basal gastric acidity than PGV-S.

[Levels of blood pepsinogen I in the offspring of patients with duodenal ulcer]. / Niveles de pepsinógeno i sérico en descendientes de ulcerosos duodenales.

Hyperpepsinogenemia I is a reliable subclinical marker of the genetical predisposition to suffer duodenal ulcer. For that reason we determine basal serum pepsinogen I (PG I) levels in 25 ulcerous patients and 75% of their offspring and to a control group matched by age and sex. PG I levels in patients and their offspring were significantly higher than those in controls and their offspring (p < 0.001). By establishing an upper normal value of PG I, we identified a subpopulation of normopepsinogenemic ulcerous patients and another with high values (9 normo PG I: 64.3 +/- 6.2 ng/ml vs 16 ulcerous patients with PG I levels: 142.1 +/- 19 ng/ml) (p < 0.001). Of 16 hyperpepsinogenemic patients, 11 offspring (27%) had increased values, what did not happen to any of the offspring of ulcerous patients with normal PG I or control group finding that 80% of male patients with high PG I gave birth to 1 or 2 children with increased values, suggesting a transmission thorough the male character. So gentic role plays an important place in our ulcerous patients but environmental factors appear to decisively influence on the establishment of the disease.

Effects of tactical late-season treatments with ivermectin on calves naturally exposed to trichostrongyles.

This study was conducted to evaluate the effects of tactical treatments with ivermectin against trichostrongyles in first-season grazing heifer calves in the Danish marshland. A group of Black-Pied Friesian calves was turned out in early May on a permanent pasture naturally infected with trichostrongyle larvae. In late July, when high herbage infectivity started to appear, the pasture was divided into two plots of equal size, which from then and until housing in late October were each grazed by half of the original group of calves. One of these groups was given three anthelmintic treatments with ivermectin at 4-week intervals starting in late July. The other group served as non-treated controls. Ostertagia ostertagi and Cooperia oncophora were the predominant trichostrongyles. Nematodirus helvetianus was observed on few occasions. Although the animals were exposed to a high herbage infectivity from July onwards, the anthelmintic treatments conferred a significant reduction in trichostrongyle loads, as evidenced by an almost complete cessation of egg excretion and a significant lowering of pepsinogen and gastrin levels in the blood. This was reflected in higher weight gains.

[Serum pepsinogen I levels in bleeding duodenal ulcer]. / Níveles de pepsinógeno I sérico en el ulceroso duodenal sangrante.

We compared serum Pepsinogen I (PG I) levels in 25 bleeding duodenal ulcer patients, 25 non bleeding duodenal ulcer (DU) patients and 25 healthy subjects, matched by age and sex. Mean values of PG I in bleeding DU patients were slightly higher than those in non bleeding DU patients, such difference was not statistically significant. Nevertheless, it must be pointed out that 88% of hemorrhagic patients had increased PG I levels compared to 72% of non hemorrhagic patients. The difference between these two groups and the healthy group was highly significant (p < 0.001). We conclude that determination of serum PG I levels is a sensitive complementary diagnostic test in the ulcerous patient. Its capacity, however, to discriminate between bleeding and non bleeding DU patients failed to be found in these study. So, hemorrhage is always a challenge in the natural history of the duodenal ulcer patient.