Value of ascitic fibronectin and cholesterol concentration in the differentiation between malignancy-related and non-malignant ascites.

In this prospective study, we tried to evaluate various "humoral tests of malignancy" regarding their efficiency of discriminating between malignancy-related and non-malignant ascites. Fibronectin, total protein, number of cells, LDH, pH, specific gravity and cytology were compared in the ascitic fluid of 51 patients with malignancy-related and 52 patients with non-malignant ascites; patients with tuberculous peritonitis were not included. Ascitic fluid cholesterol was determined in 36 of 51 malignancy-related and in 37 of 52 non-malignant ascites. Cytology and fibronectin were found 100% specific with diagnostic efficiency 87.5% and 94.2% respectively under optimal conditions. Cholesterol was neither sensitive nor specific. It is concluded that fibronectin was a valuable test for malignancy-associated ascites.

Significance of various factors in patients with functional dyspepsia and peptic ulcer disease in Greece. A comparative prospective study.

This prospective study was undertaken to evaluate the significance of factors such as age, sex family history, educational status, residence area, H pylori antral colonization, smoking, alcohol consumption, coffee and cola drinking in Greek patients suffering from functional dyspepsia (FD), duodenal ulcer (DU), and gastric ulcer (GU). The study groups were chosen among consecutive outpatients who had undergone an upper gastro-intestinal (GI) endoscopy during a ten-month period because of dyspepsia, and who completed a suitable questionnaire; 295 patients aged 18-85 years (M: 185, F: 110) were finally included as follows: 54 patients aged 18-80 years M: 21, F: 33) with FD, 166 aged 19-85 years (M: 117, F: 49) with DU, and 75 aged 24-85 years (M: 47, F: 28) with GU. As controls for FD patients, 54 previously studied, healthy non-dyspeptic people, well matched for age and sex, were used. No differences were found between them and FD patients. On the contrary, we found that the 3 groups of patients differed significantly for age (p = 1.07 x 10(-3)) and sex (p = 1.67 x 10(-4)) distribution. There was a rather even age distribution and a discrete female predominance in the FD group. Positive family history for peptic ulcer disease (PUD) was found in 19% of patients with FD as compared with 48.2% (DU) and 37% (GU) (p = 4.84 x 10(-4)). Significantly more patients with PUD were smokers (p = 6.16 x 10(-3)) and alcohol drinkers (p = 1.84 x 10(-4)). H pylori antral colonization was found in 61% of patients with FD as compared with 74% (GU) and 85% (DU) (p = 8.65 x 10(-4)) of patients. Finally, factors such as educational level, area of residence, and cola drink consumption did not differ in the studied groups of patients.

Changes in blood glucose induced by upper GI diagnostic endoscopy: the influence of various premedications.

In this study we measured the blood glucose before and after diagnostic upper GI endoscopy as an index of the stress induced by the procedure. The possible influence of various premedications in the blood glucose was also studied. One hundred and twenty consecutive non-diabetic patients of both sexes aged 20-75 years were randomly allocated into four groups (A,B,C,D) according to the premedication used. Sixty non-diabetic patients, who were not endoscoped, were allocated into three groups (C1, C2, C3) and served as controls. Blood glucose increased significantly in the patients but not in the controls. No correlation was found between the changes in the blood glucose and the time needed for the endoscopy. Changes in the blood glucose did not differ among the patients (F = 0.214; p = 0.886) irrespective of the premedication; however the increase was numerically less when 10% lidocaine spray was used as a premedication (Groups A and C). It is concluded that diagnostic upper GI endoscopy induced a significant increase in blood glucose, irrespective of the premedication. This increase seemed to be mainly the result of the stress induced by the irritation of the pharynx during the intubation.

Non-cardia gastric adenocarcinoma and Helicobacter pylori infection.

The seroprevalence of IgG antibodies to Helicobacter pylori (Hp-Ab) was studied in 47 patients (29M, 18F, mean age +/- SD: 62.44 +/- 12.63 years) with non-cardia gastric carcinoma using an enzyme-linked immunosorbent assay. Controls were: a) 50 healthy people well-matched with the cancer patients; b) 50 patients with dyspepsia well matched with the cancer patients. Hp-Ab were detected in 72.3% of patients with gastric carcinoma, in 68% of healthy people and in 88% of dyspeptics. No significant associations were found between H. pylori infection and gastric cancer patients as a whole (odds ratio: 1.23, 95% CI: 0.514-2.95). In addition, no significant associations were found between H. pylori infection and the various subsets of cancer patients. These findings do not support an association between H. pylori infection and non-cardia gastric carcinoma in Greece.

Six-month maintenance treatment of duodenal ulcer with sucralfate: influence on antral gastritis and Helicobacter pylori antral colonization--a prospective uncontrolled study.

Fifty-four patients (41 men, 13 women), aged 17 to 78 years (mean +/- SD, 48.13 +/- 13.5 years), with endoscopically confirmed healing of their duodenal ulcer after treatment with sucralfate (2 gm BID for 4 to 8 weeks) were recruited for this study. They were started on a 6-month maintenance treatment with sucralfate 1 gm BID. Endoscopy was done at the end of the 6-month period or whenever there was any evidence of ulcer relapse. Helicobacter pylori antral colonization (CLO test) and antral gastritis were estimated from biopsy samples taken before, and at the end of, the healing treatment, as well as at the end of the maintenance treatment. Cumulative relapse rate after 6 months was 15% (8 of 54). No patient discontinued treatment because of side effects. No influence of sucralfate on H pylori antral colonization or antral gastritis was observed after the healing or maintenance treatment. It is concluded that sucralfate 1 gm BID for 6 months is an effective maintenance treatment for duodenal ulcer, but has no beneficial effect on either H pylori antral colonization or antral gastritis.

Serum protein markers (Hp, GC, C3) in patients with colon cancer.

The phenotypes and gene frequencies of three serum protein systems--Hp, GC and C3--were studied in 184 consecutive patients from all over Greece with colon cancer. Healthy Greeks studied previously in our department served as controls. No significant differences were found between patients and controls concerning GC and C3. Significant differences were found in the Hp system; the frequencies of the Hp*1 gene and the Hp 1-1 phenotype were significantly higher in patients than in controls.

Herpes simplex virus types 1 and 2 and cytomegalovirus in peptic ulcer disease and non-ulcer dyspepsia.

The prevalence and the serum levels of IgG antibody to Herpes simplex virus type 1 or 2 (HSV1, HSV2) and to cytomegalovirus (CMV) were studied by ELISA in patients with active peptic ulcer -- duodenal and gastric -- and non-ulcer dyspepsia. Two hundred and forty-two consecutive patients with endoscopically confirmed active peptide ulcer -- 170 duodenal ulcers, 72 gastric ulcers -- and 95 consecutive patients who fulfilled the criteria for the diagnosis of non-ulcer dyspepsia were included in the study. The patients, aged 17-80 years, were well matched for age and sex. Antibody to cytomegalovirus was found in 83% of duodenal ulcer, 85% of gastric ulcer and 75% of non-ulcer dyspepsia patients; differences were not significant. The prevalence of HSV1 antibody was significantly higher in patients with duodenal ulcer than in those with non-ulcer dyspepsia (p < 0.025); the prevalence of HSV2 antibody was significantly higher in patients with duodenal or gastric ulcer, than in those with non-ulcer dyspepsia (p < 0.05, p < 0.01, respectively); however, antibody levels (mean optical density) to the viruses studied were similar for all groups of patients. These results provide some evidence that HSV might be implicated in the pathogenesis of peptic ulcer disease.

Preliminary observations in the fasting serum gastrin in patients with duodenal ulcer; further evidence of the "clearing" effect of omeprazole on H pylori?

Thirty patients with active duodenal ulcer who were Helicobacter pylori positive (HP+) by HLO test and by histology (Giemsa stain) were given omeprazole (OME) 20 mg/d for a two-week period. Estimation of fasting serum gastrin concentration (RIA) was performed before treatment and 24 hours after the last dosage of OME, and HP was searched for an antral biopsies at the end of the treatment as well. Mean fasting serum gastrin concentration increased significantly after treatment in all patients studied (p less than 0.05). However, the increase remained significant only in those patients who continued to be HP+ while no significant increase was observed in those who became HP-. The results could be considered as further evidence of the 'clearing' effect of Omeprazole on HP.

Serum protein groups (Hp, GC, C3) in patients with gastric carcinoma.

The phenotypes and gene frequencies of 3 serum protein systems (Hp, GC and C3) were studied in 114 consecutive patients from all over Greece with gastric carcinoma. Healthy Greeks studied previously in our Department served as controls. No significant differences were found between patients and controls concerning Hp. Significant differences were found in the GC and C3 systems; GC 2-1 and C3F phenotype as well as C3*F gene frequencies were significantly higher in patients than in controls.

GC and C3 serum groups in peptic ulcer.

The phenotypes and gene frequencies of two serum protein systems (GC, C3) were studied in 238 consecutive patients with peptic ulcer from all over Greece. 173 patients had duodenal ulcer and 65 had gastric ulcer. Healthy Greeks studied previously in our department served as controls. No significant differences were found between the studied groups and the controls as far as GC was concerned. However, significant differences emerged in C3; the C3*F gene was almost twice more common and the C3F phenotype almost three times more frequent in patients than in controls.

Sucralfate and ranitidine twice daily in the treatment of gastric ulcer. A multicenter randomized double-blind study.

Sucralfate and ranitidine were compared in the treatment of gastric ulcer (GU) in this multicenter randomized double-blind study. Sixty-four patients with endoscopically diagnosed GU initially included in the trial were randomly assigned to treatment with sucralfate, 2 g b.i.d. (morning and evening on an empty stomach), or ranitidine, 150 mg b.i.d. Nine patients were subsequently excluded for various reasons. The remaining 55 were examined endoscopically after 4 and, if unhealed, 8 weeks. At 4 weeks, 54.2% (13 of 24) of the sucralfate group had a healed ulcer, in comparison to 45.2% (14 of 31) of the ranitidine group (NS). At 8 weeks, cumulative healing rates were 87.5% (21 of 24) and 84% (26 of 31), respectively (NS). No differences were found in the healing effects of the drugs on smokers and nonsmokers or in side effects. These results suggest that both drugs are equally effective in the short-term treatment of GU.

Comparison of sucralfate and ranitidine twice daily in duodenal ulcer treatment: a multicenter randomized double-blind study.

Sucralfate and ranitidine were compared in the treatment of duodenal ulcer in this multicenter, randomized, double-blind study. A total of 165 patients with endoscopically proven duodenal ulceration were included in the trial and randomized to treatment with sucralfate, 2 g b.i.d. (morning and evening with an empty stomach), or ranitidine, 150 mg twice daily. All patients were endoscopically examined after 4 and, if unhealed, 8 weeks. Of the patients considered suitable for analysis at 4 weeks, 73.5% (61 of 83) of the sucralfate group demonstrated healing of the ulcer in comparison with 63.3% (50 of 79) of the ranitidine group. At 8 weeks cumulative healing rates were 89% (74 of 83) and 84.8% (67 of 79), respectively. When smokers were considered separately, healing rates at 4 weeks were 69.2% (36 of 52) for sucralfate and 53.3% (24 of 45) for ranitidine. At 8 weeks cumulative healing rates were 92.3% (48 of 52) and 77.7% (35 of 45), respectively (p less than 0.05). Overall, there was no difference in the two groups regarding symptom relief and side effects. These results suggest that these drugs are equally effective in the short-term treatment of duodenal ulcer, although in smokers sucralfate appears to be more effective than ranitidine.

Effect of omeprazole on H. pylori after two weeks of treatment.

The "clearing" effect of omeprazole 20 mg/daily on Helicobacter pylori (HP) was studied in 32 HP positive patients with duodenal ulcer (DU). Endoscopy and antral biopsies were made before and after two weeks of treatment with Omeprazole. HLO test and histology after Giemsa stain were used for the detection of HP. Fourteen of 28 (50%) initially HLO positive and 12 of 30 (40%) initially histological HP positive patients became HP negative. Nine of 23 (39%) patients, initially HP positive by both methods became HP negative. "Clearing" of HP in this particular group of patients did not have any influence on ulcer healing. It is concluded that omeprazole used for two weeks has a clearing effect on HP in a high enough percentage of patients with DU.