Determination of alpha-1 antitrypsin genetic deficiency in duodenal ulcer by polymerase chain reaction.

OBJECTIVE: To confirm alpha-1-AT deficiency status in duodenal ulcer using a combination of PCR and restricted enzyme digestion. METHODS: Fifty patients with endoscopically proven duodenal ulcer and hundred controls with no signs of the disease were included. Alpha-1-AT phenotypes were confirmed by polymerase chain reaction followed by restriction enzyme digestion. RESULTS: Alpha-1-AT concentration in duodenal ulcer patients showed a mean value of 2.12 +/- 0.11 g/l (range: 0.52-3.95 g/l, p < 0.05). In controls this was 2.47 +/- 0.08 g/l (range: 0.52-5.0 g/l). Among the controls 70% had the MM phenotype, 28% M1 M2 and 2% FM. In duodenal ulcer, MM predominates (70%), followed by M1 M2 (18%), SS (4%), SZ (4%), ZZ (2%) and MZ (2%). CONCLUSION: Alpha-1 AT deficiency was found in 10% of duodenal ulcer patients. DNA analysis more accurately resolved the phenotypes as S and Z mutations.

Efficacy of albendazole in giardiasis.

Albendazole and metronidazole were compared in 68 patients diagnosed positive for giardiasis. Albendazole 1200 mg, one dose was given to 24 patients, albendazole 400 mg twice a day for 3 days was given to 23 patients, and metronidazole 400 mg 3 times a day for 5 days to 21 patients. Response to therapy was monitored by clinical examination and analysis of fresh faecal samples on days 0, 3, 7 and 10. Response to the single dose of albendazole was 55%, to the divided dose of albendazole 70%, and to metronidazole 84%. The results show that albendazole, originally recommended for helminthic infection, can also be used in patients with mixed protozoal infection or for infections resistant to metronidazole.

Efficacy of albendazole in giardiasis

Albendazole and metronidazole were compared in 68 patients diagnosed positive for giardiasis. Albendazole 1200 mg, one dose was given to 24 patients, albendazole 400 mg twice a day for 3 days was given to 23 patients, and metronidazole 400 mg 3 times a day for 5 days to 21 patients. Response to therapy was monitored by clinical examination and analysis of fresh faecal samples on days 0, 3, 7 and 10. Response to the single dose of albendazole was 55%, to the divided dose of albendazole 70%, and to metronidazole 84%. The results show that albendazole, originally recommended for helminthic infection, can also be used in patients with mixed protozoal infection or for infections resistant to metronidazole

Phenotypes of alpha 1 antitrypsin in Karachi, Pakistan.

OBJECTIVE: To determine serum level of the protease inhibitor, to identify phenotypes and determine their frequencies. STUDY DESIGN: A prospective study. SETTING: PMRC, Research Centre, JPMC and the Aga Khan University Hospital, Karachi. SUBJECTS: Healthy adults without history of peptic ulcer disease and a normal endoscopy. METHODOLOGY: Quantitative measurement of serum alpha 1 AT was carried out by radial immunodiffusion, phenotyping by iso-electric focusing and confirmation of phenotypes by immuno-fixation and DNA analysis technique. RESULTS: Serum alpha 1 AT was low in 13.4% of the subjects. MM phenotype predominated followed by SZ, SS,MZ and ZZ. DNA diagnosis accurately resolved the phenotypes as S and Z. CONCLUSION: Frequency of phenotype associated with total and intermediate deficiency is less in the population.

Does the rapid healing of duodenal ulcers mean longer remissions?

A study was conducted to test the response to therapy and the relapse rates of endoscopically-confirmed duodenal ulcers. Endoscopy to check for healing was performed at 4 and 8 weeks in cases receiving H2-blockers and misoprostol and at 14 and 28 days in cases receiving a proton pump inhibitor. Endoscopy was repeated at 1, 3, 6 and 12 months to check for relapses. Healing rates were 61%-77% and 75%-85% at 4 and 8 weeks in the group receiving H2-blockers and misoprostol. Healing rates were 68% and 100% at days 14 and 28 with the proton pump inhibitor. The relapse rates within 3 months were 72%-86% and 100% respectively. This study indicates that the faster the ulcer healed, the earlier the relapse occurred

Genetic markers and duodenal ulcer.

Serum pepsinogen, alpha 1-antitrypsin (alpha 1-AT) and blood groups were studied as genetic markers in 32 patients with endoscopically proven duodenal ulcer and 44 control subjects with no family history of ulcer disease. Serum pepsinogen was determined by the modified method of Edward et al, alpha 1-AT by single radial immunodiffusion (RID) and phenotyping was carried out by isoelectric focusing (IEF). Duodenal ulcer patients with hyper- pepsinogenemia (28%) and low serum alpha 1-AT (35%) had a dominant blood group O, lower mean age, an early onset of disease, a higher frequency of gastrointestinal (GI) bleeding and ulcer perforation. These parameters were found considerably different in patients with normal serum pepsinogen and alpha 1-AT. Phenotype analysis of alpha 1-AT revealed that four duodenal ulcer patients had partial deficiency of the protease inhibitor and none of the normal exhibited the deficiency pattern. The etiology of the disease appears to be genetic anomaly in 28% of patients while the rest (72%) had ulcers as a result of neuroendocrinological or environmental factors.

Roxatidine versus ranitidine in the treatment of patients with duodenal ulcer: a randomized, double-masked, multicenter study.

The comparative efficacy of roxatidine and ranitidine in the treatment of patients with acute duodenal ulcer was assessed at 4 and 6 weeks in this multicenter study. Ninety-four of 192 patients were given roxatidine in a single nightly dose of 150 mg, and 98 patients were given ranitidine in a single nightly dose of 300 mg. All the patients had endoscopically proven duodenal ulcer. Of the 171 assessable patients, ulcers were healed in 88% of the roxatidine group (73 of 83) and in 84% of the ranitidine group (74 of 88). No serious adverse events were reported in either group. We conclude that roxatidine 150 mg once daily is as effective and safe for the treatment of acute duodenal ulcer as ranitidine 300 mg once daily.

Triple therapy in duodenal ulcer healing--a follow up study.

Thirty-nine Helicobacter pylori (HP) positive chronic duodenal ulcer patients completed the 4 weeks treatment of triple therapy (Denol, Metronidazole and Amoxil). Of these 29 showed healed duodenal ulcer and negative CLO test at 8 weeks (eradication). They were followed at 3,6 and 12 months and at each follow-up, endoscopy and CLO testing were repeated. At 12 weeks, 54% showed a healed ulcer and negative CLO and these figures reached to 69 and 66% at 6 and 12 months respectively. Thirty percent relapsed within 1 year. The present study indicates a prolonged remission of duodenal ulcer following HP eradication.

Endoscopic re-evaluation of Visick grading.

Correlation of Visick grading was done with serial endoscopies in 19 patients operated for duodenal ulceration. Deeper mucosal lesions like ulceration showed good association with Visick grading (100%), while superficial mucosal lesions were mostly asymptomatic and therefore, caused disparity in grading. Moreover, as symptoms and endoscopic findings changed with passage of time, it was concluded that in the light of endoscopic findings the grading need re-evaluation.

Serum alpha 1 antitrypsin and pulmonary emphysema.

Using isoelectric focusing (IEF) and radial immunodiffusion (RID) techniques, serum samples from 100 normal healthy adults and 21 patients with pulmonary emphysema were analysed to identify various alpha 1 antitrypsin phenotypes and the serum concentrations. Ten percent of the patients had low serum values. The normal or most common genetic form, MM, is the predominant phenotype in both controls and patients.