Inflammatory map of the gastroduodenal mucosa in patients with upper gastrointestinal symptoms. The role of H. pylori infection.

INTRODUCTION AND AIM: The gastric mucosa has been studied since the pre-Helicobacter pylori (H. pylori) era, but the complete descriptions of the stomach and duodenum have been anecdotal, and those of the distal duodenum, exceptional. Our aim was to evaluate the different epidemiologic characteristics and the gastroduodenal inflammatory status in patients with upper gastrointestinal symptoms. MATERIALS AND METHODS: We studied 138 patients divided into: the non-ulcer group (functional dyspepsia [n = 77] and GERD [n = 27]) and the ulcer group (peptic ulcer [n = 13] and duodenal ulcer [n = 21]). Ten biopsy samples (2 from the corpus, 3 from the antrum, 3 from the proximal duodenum, and 2 from the distal duodenum) were taken in each patient for histologic and/or microbiologic study. RESULTS: The prevalence of dyspepsia, functional dyspepsia, and H. pylori was 80.4%, 69.4%, and 82.6%, respectively. The frequency of superficial chronic gastritis in the corpus was significantly higher in the ulcer group vs. the non-ulcer group, whereas there was more chronic atrophic gastritis in the antrum in the ulcer group (P < 0.05). Duodenitis was significantly more frequent in the ulcer group vs. the non-ulcer group, in both the proximal and distal duodenum. Pangastroduodenitis was a significant finding in the ulcer group. In both groups, chronic gastritis (corpus and antrum) and duodenitis (proximal and distal) were significantly related to the presence of H. pylori. Proximal duodenitis is not an uncommon finding in functional dyspepsia (37.7%) and is twice as frequent as distal duodenitis (16.9%). CONCLUSIONS: The ulcer group presented with a gastroduodenal inflammatory map different from that of the non-ulcer group and was characterized by a higher frequency of superficial chronic gastritis in the corpus, chronic atrophic gastritis in the antrum, and a very high frequency of proximal duodenitis.

Comparación del riesgo de hemorragia digestiva alta asociado a diferentes anti-inflamatorios no esteroideos / Comparison of the risk of upper gastrointestinal bleeding associated with non-steroidal anti-inflamatories

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Epidemiología de la dispepsia en una comunidad del sur de España. Prevalencia de la infección por Helicobacter pylori / Epidemiology of dyspepsia in a random mediterranean population. Prevalence of Helicobacter pylori infection

OBJETIVO: la verdadera prevalencia de la dispepsia en la comunidad es poco conocida, pues la mayoría de los estudios se han realizado sobre muestras no representativas de la -población general. El objetivo fue estudiar la prevalencia de la dispepsia en una muestra aleatoria de una población general, así como sus características sociodemográficas y epidemiológicas. DISEÑO EXPERIMENTAL Y PARTICIPANTES: se realizó un estudio epidemiológico prospectivo basado en una encuesta directa y personal en una muestra de 264 sujetos, elegida al azar, entre una población del sur de España. RESULTADOS: la prevalencia de dispepsia fue del 24 por ciento, sin apreciarse relación entre ésta y diversos parámetros demográficos, hábitos tóxicos o subgrupos de dispepsia. El 49 por ciento de la población se automedicaba y el 44 por ciento acudió en busca de ayuda médica por su dispepsia. Mostraron un síndrome de intestino irritable 36 sujetos (13,6 por ciento) y 20 de ellos referían también síntomas de dispepsia (55,5 por ciento). Habían sido investigados 40 sujetos con dispepsia (80 por ciento mediante radiología con papilla de bario, 45 por ciento con ecografía y 18 por ciento con gastroscopia), obteniéndose un diagnóstico de enfermedad orgánica en el 45 por ciento de ellos. El subgrupo de dispepsia similar a reflujo gastroesofágico fue el más frecuente (60 por ciento), observándose un amplio solapamiento entre los diversos subgrupos de dispepsia. Los anti-H. Pylorí-IgG fueron positivos en el 52 por ciento, pero no hubo relación entre la infección bacteriana y la presencia de dispepsia. CONCLUSIONES: la dispepsia afecta a una cuarta parte de nuestra población, asociándose a síndrome de intestino irritable en la mitad de los casos, pero sin relación con la presencia de una infección por H. pylori (AU)

Epidemiología en gastroenterología: ¿tienen los números algún valor? / Epidemiology in gastroenterology: have numbers any value?

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Epidemiology of dyspepsia in a random mediterranean population. Prevalence of Helicobacter pylori infection.

AIM: The prevalence of dyspepsia in the community is poorly known, because most studies have used samples that were not representative of the general population. This study was intended to determine the prevalence of dyspepsia in a random sample of the general population, and its epidemiologic and sociodemographic characteristics. METHODS: In this descriptive study we used a questionnaire administered during a personal interview to survey a random sample of 264 subjects in a Mediterranean population. RESULTS: The prevalence of dyspepsia was 24%; we found no relation between prevalence and demographic characteristics, smoking and drinking, or type of dyspepsia. Forty subjects with dyspepsia were examined and the specific diagnosis was found in 18 (45%) of them. The subgroup with reflux-like dyspepsia was the largest (60%), although there was considerable overlap between subgroups with reflux-like, ulcer-like and dysmotility-like dyspepsia. Anti-Helicobacter pylori antibodies (IgG) were found in 52% of the subjects, but bacterial infection was not related with dyspepsia. CONCLUSIONS: Up to one-fourth of the general population in the city where the subjects reside may have dyspepsia. This disorder was associated with irritable bowel syndrome in half of the cases, but was not associated with H. pylori infection.

Are there changes in gastric emptying during the menstrual cycle?

BACKGROUND: The questions of whether gastric emptying of solids and liquids differs in men and women and whether emptying is influenced by the action of sex hormones on gastric smooth muscle remain unresolved. METHODS: We analysed the gastric emptying of digestible solids (GES), liquids (GEL), and radiopaque indigestible solids (GER) in three groups of healthy volunteers: 50 women in the follicular phase of the menstrual cycle, 50 women in the luteal phase, and 100 men. [99mTc]-labelled diethylenetriamine pentaacetic acid (DTPA) was used as the radioactive marker for digestible solids, and [111In]DTPA was used as the marker for liquids, to time gastric motility after a solid and a liquid meal. GER was evaluated on a different day in abdominal roentgenograms. RESULTS: GES and GEL were slower in women than in men (P < 0.05), but GER was similar in the two sexes. However, there were no significant differences in GES, GEL, or GER between women in the follicular and those in the luteal phase, between plasma concentrations of oestradiol and progesterone and the variables used to characterize gastric emptying. CONCLUSIONS: Evidence of postprandial 'physiologic gastroparesis' was found in women, although no differences were found between men and women in gastric motility during fasting. The rate of emptying was not related to changes in plasma concentrations of sex hormones during the menstrual cycle.

Altered gastric emptying in patients with irritable bowel syndrome.

Irritable bowel syndrome is the most frequent functional disorder of the digestive system. Patients with irritable bowel syndrome have motor disorders not only in the colon, but also in other parts of the digestive tract such as the oesophagus and small intestine; however, it is not known whether the stomach is also involved. We used a radiolabelled mixed solid-liquid meal (technetium-99m for the solid component, indium-111 for the liquid component) to study gastric emptying of solids (GES), liquids (GEL) and indigestible solids (GER) in 50 patients diagnosed as having irritable bowel syndrome (30 with predominant constipation and 20 with predominant diarrhoea). GER was measured by counting the number of indigestible solids remaining in the stomach 4 h after they were swallowed. In patients with irritable bowel syndrome, GES and GEL were slower than in control subjects (P<0.05). GER was normal in all patients except for two women. Thirty-two patients (64%) showed delayed GES, 29 (58%) delayed GEL, and 2 (4%) delayed GER. Among patients with irritable bowel syndrome, GES was slower in those with predominant constipation than in those with predominant diarrhoea (P<0.05); GEL and GER were similar in both groups. Gastroparesis was found in a large proportion of patients with irritable bowel syndrome, suggesting the presence of a more generalised motor disorder of the gut.

Irritable bowel syndrome in patients with dyspepsia: a community-based study in southern Europe.

OBJECTIVES: Dyspepsia and irritable bowel syndrome (IBS) share aetiopathogenic factors, and may therefore be part of a single disorder. This study was intended to determine their prevalence in the general population, and the degree of overlap between these two digestive disorders. DESIGN: Descriptive study. METHODS: A sample of 264 subjects chosen randomly from the population census of a city in Spain, and considered representative of the general population in this city, was surveyed by questionnaire. RESULTS: The prevalence of dyspepsia was 23.9%, and that of IBS was 13.6%. Of the subjects with dyspepsia, 31.6% had IBS, and of the subjects with IBS, 55.6% reported symptoms of dyspepsia. The prevalence of IBS was higher among subjects with dyspepsia (31.7%) than among those who reported no symptoms of dyspepsia (7.9%; P < 0.05). Moreover, the prevalence of IBS was similar in three subgroups identified according to the type of dyspepsia described (ulcer-like, reflux-like or dysmotility-like). When we compared subjects with both dyspepsia and IBS and those with dyspepsia alone, we found no significant differences in clinical characteristics except for abdominal pain and fear of cancer, which were more frequent in the former. Of the entire sample, 27.7% of the subjects sought medical attention for IBS and 17% missed work because of IBS. CONCLUSION: Our findings suggest that functional dyspepsia and IBS are two manifestations of a single, more extensive digestive system disorder.

[Endoscopic, histologic and morphometric evaluation of the gastric mucosa in patients with osteoarthritis treated with piroxicam and zinc acexamate]. / Evaluación endoscópica, histológica y morfométrica de la mucosa gástrica en pacientes con osteoartritis tratados con piroxicam y acexamato de cinc.

Zinc acexamate (ZAM) is an antiulcer agent with antisecretory and gastroprotective properties. The aim of this study was to evaluate endoscopically and morphometrically the efficacy of ZAM in the prophylaxis of gastroduodenal lesions induced by pyroxicam. Thirty nine patients from 30 to 70 years of age diagnosed with osteoarthritis without lesions in the upper digestive tract on basal endoscopy were studied. A randomized, double blind study was designed in which the patients received 20 mg/day of pyroxicam together with 300 mg/day of ZAM or placebo for 4 weeks. Clinical controls were undertaken on days 0, 14, 28 and endoscopic and histologic controls performed on days 0 and 28. The two groups were homogeneous regarding basal parameters. Endoscopic grading of the gastroduodenal lesions at the end of the study was lower in the group treated with ZAM (p < 0.001). Ulcers were found in only 2 patients (one antral and one duodenal) both of whom were in the placebo group (10.5%). Histologic scoring following treatment demonstrated higher values in the placebo group (p < 0.001) and scarce alterations with respect to base values in the group treated with ZAM. Morphometric quantification showed lower cell densities in both groups at the body level (p < 0.001). However, these did not vary in the antrum in the group treated with ZAM but increased in the placebo group (p < 0.001) as an expression of proliferative cell response to mucosal damage. At a single nightly dosis of 300 mg ZAM is effective in the prophylaxis of gastric and duodenal lesions induced by pyroxicam.

[Asymptomatic chronic intrahepatic cholestasis and multiple hypodense nodules in the liver and the spleen: manifestations of a case of sarcoidosis]. / Colestasis intrahepática crónica asintomática y múltiples nódulos hipodensos en hígado y bazo: manifestaciones de un caso de sarcoidosis.

Sarcoidosis is a systemic granulomatous disease of unknown etiology which may present multiple clinical manifestations. Liver involvement is observed among 21-79% of the cases. Nonetheless, hepatic sarcoidosis is usually asymptomatic and the finding of cholestasis is an infrequent complication. In the last few years, the presence of multiple hypodense nodules in the liver and spleen has been described in 5-15% of these patients following the application of dynamic intravenous techniques in abdominal CT scan. Although the histopathologic study of these nodules suggests that their formation is due to the coalescence of the microscopic granulomas, the cause of this aggregation remains unknown. A case of hepatic sarcoidosis presenting chronic cholestasis and whose abdominal tomographic study with intravenous contrast demonstrated the existence of hypodense lesions in the liver and spleen suggesting malignant disseminated disease is reported.

Dyspeptic symptoms and gastric emptying of solids in patients with functional dyspepsia. Role of Helicobacter pylori infection.

BACKGROUND: Our aim was to investigate the relation between dyspeptic symptoms, gastric emptying of digestible and indigestible solids, and Helicobacter pylori infection in patients with functional dyspepsia. METHODS: We used isotopic labeling and radiologic techniques to study gastric emptying of a solid meal and of 10 radiopaque indigestible solids in 50 healthy volunteers and 50 patients with functional dyspepsia. In addition, we determined the presence of seven symptoms of dyspepsia and added the score for each symptom to obtain an index of dyspepsia for each patient. RESULTS: Seventy-eight per cent of our dyspeptic patients had gastroparesis to a solid meal, and 68% to indigestible solids. We found no apparent relation between gastroparesis or H. pylori infection and dyspeptic symptoms separately or as an index of dyspepsia. Moreover, the presence of the bacteria was not related to gastroparesis to a solid meal or to indigestible solids. CONCLUSIONS: We conclude that neither symptoms of dyspepsia nor H. pylori appears to be related to gastroparesis to solids. H. pylori infection is not related to dyspeptic symptoms.