Serum biomarkers for atrophic gastritis and antibodies against Helicobacter pylori in the elderly: Implications for vitamin B12, folic acid and iron status and response to oral vitamin therapy.

OBJECTIVES: To investigate the prevalence of serological markers for chronic atrophic gastritis (AG) and Helicobacter pylori antibodies (HPAb) in an elderly population, and to examine the interrelationship and significance for cobalamin, folic acid and iron status and response to oral vitamin therapy. MATERIAL AND METHODS: The study included community-dwelling subjects (n=209), mean age 76 years, randomized to 4 month of oral daily treatment with 0.5 mg cyanocobalamin, 0.8 mg folic acid and 3 mg vitamin B(6) or placebo (double-blind). Biochemical tests were carried out before and after treatment. RESULTS: AG, as indicated by a pepsinogen I/II ratio <2.9, occurred in 14% (26/190) and HPAb in 54% (102/190) of the subjects. AG subjects had higher levels of serum methylmalonic acid (MMA) (p<0.001), plasma homocysteine (tHcy) (p<0.05), lower haemoglobin (Hb) (p<0.01) and a higher prevalence of vitamin B(12) deficiency (p<0.01). HPAb was associated with AG, whereas AG subjects without HPAb had higher tHcy and MMA levels. There was no correlation between AG and iron status. Oral vitamin treatment led to greater (albeit non-significant) improvements in MMA, tHcy and total cobalamins in AG subjects compared to non-AG subjects. CONCLUSIONS: AG is a common condition and is a significant determinant of vitamin B(12) status. AG is correlated to HPAB and lower Hb. Elderly AG subjects respond at least as well as non-AG subjects to oral treatment with B-vitamins in the doses employed.

[New guidelines for better documentation of survey methodology and results]. / Nya riktlinjer ger bättre dokumentation av undersökningsmetoder och resultat.

Surveys of published studies on diagnostic accuracy and the performance of diagnostic tests, widely defined as any method for obtaining additional information on the health status of an individual, have revealed poor methodological quality. This holds true also for scientific journals considered to be leading in their fields. The STARD document (Standards for Reporting of Diagnostic Accuracy), which was first published in 2003, provides guidelines for the design, performance and report of such studies. Adherence to these guidelines may improve the quality of scientific publications, increased opportunities for readers to get an insight into the experimental details, improved education in medical research and increased opportunities for the disclosure of scientific fraud.

[Laboratory thyroid disease diagnosis--interdisciplinary cooperation. International consensus in Swedish perspective]. / Laboratoriemässig tyreoideadiagnostik --samarbete over disciplingränserna. Internationell konsensus i svenskt perspektiv.

In 2003, The National Academy of Clinical Biochemistry published a consensus monograph on thyroid tests (available via Internet from 2002). The document, a result of international collaboration, describes the pathophysiological background and clinical application of the measurements as well as principles for their technical performance. Of value, and of definite clinical relevance, is the detailed description of factors affecting the results in health and disease. However, we lack a description of the sometimes large differences in values obtained with different generally available methods, as well as a presentation of the occurrence and evaluation of analytical interference and related technical factors affecting results. Readers with little experience from quantitative measurement in the clinical laboratory, therefore, are not stimulated to obtain a better understanding of causes and evaluation of unexpected results.

[New service for laboratory investigation of problematic cases. Four patients illustrate the value of EQUALIS]. / Ny möjlighet till laboratorieutredning av oklara fall. Fyra patientfall illustrerar värdet av EQUALIS.

In 1996, the Endocrinology Group in EQUALIS, in collaboration with The Thyroid Unit at The Section of Endocrinology at Sahlgrenska University Hospital, introduced a "patient-related" quality assurance program. Serum samples from patients with established or suspected thyroid disorder and/or results from thyroid-related biochemical measurements which were at variance with the clinical presentation, were analyzed by the participants of an external quality assurance program in endocrinology. The results from this program were informative as regards capacity, in the individual laboratories, for the evaluation of analytical and/or biological factors causing unexpected results from the measurement of thyroid-related serum components. We now present four clinical cases, which had offered diagnostic problems. EQUALIS, in collaboration with the participants of the external quality assurance program in endocrinology and on the basis of experiences from this program, now offers a diagnostic service for clinical chemistry laboratories and physicians when they are confronted with unexpected results from the immunochemical measurement of analytes included in the program.

Bone mineral density in patients with small intestinal bacterial overgrowth.

BACKGROUND/AIMS: Malabsorption has long been recognized as a cause of osteopenia, and mild forms of osteopenia are present in many gastrointestinal disorders. The aim of this study was to determine if osteopenia is common in patients with small intestinal bacterial overgrowth. METHODOLOGY: Bone mineral density was measured in fourteen patients with small intestinal bacterial overgrowth. Patients with obvious structural predisposing conditions such as previous gastric operations, small bowel strictures and small bowel diverticula, were excluded. Measurements were made in the distal right radius and ulna, in the hip and in the spine. The results were compared to those of a reference population. Radiographs of the spine were assessed for evidence of vertebral fractures. Blood samples were analyzed for serum concentrations of 25-hydroxyvitamin-D3 and 1,25-dihydroxyvitamin-D3, alkaline phosphatase activity, ionized calcium, intact parathyroid hormone and osteocalcin. All patients completed a questionnaire concerning, inter alia, previous fractures, past and current diseases, tobacco smoking and medication. RESULTS: Patients with small intestinal bacterial overgrowth had significantly low bone density in the femoral neck (p < 0.01) and in the lumbar spine (p < 0.05), compared to a reference population. Six of 14 (43%) patients had had fractures. CONCLUSIONS: Patients with small intestinal bacterial overgrowth have low bone mineral density. In patients with osteopenia of unknown origin, small intestinal bacterial overgrowth should be considered.

[Report from the congress on andrology in Montreal. Diagnosis and treatment of the "andropause"]. / Rapport från Montrealkongressen om andrologi. Diagnostik och behandling av "andropausen".

As reflected by the proceedings of the recent VIIth International Congress of Andrology in Montreal, Canada, modern andrology takes a wider responsibility for men's health than previously. The area has expanded not only into the fields of basal and clinical endocrinology but also into paediatrics and geriatrics. These changes also put pressure on laboratories of clinical chemistry to provide new and clinically more relevant endocrinological investigations such as lutropin assays which detect the biologically active isoforms, and assays of "bioavailable" testosterone, as well as of inhibin B and anti-Müllerian hormone.

[Increased risk of bone-fragility-related fractures in TSH--suppressive thyroxine treatment]. / Okad risk för benskörhetsfraktur vid TSH-suppressiv tyroxinbehandling.

Low concentration of serum thyrotropin (TSH) is a common finding in patients attending primary care as well as in apparently healthy elderly individuals. Low TSH concentration in apparently healthy elderly seems to be a significant risk factor for the development of dementia and for premature mortality. In thyroxine-treated women, TSH < 0.10 mlU/L appears to be a significant risk factor for fractures of the hip and vertebrae. Considering also the decrease in anti-thyroid immunoactivity observed in thyroxine treatment of autoimmune thyroiditis, as measured with antithyroperoxidase antibodies, we conclude that TSH concentrations during thyroxine substitution treatment should be held within the lower end of the health-associated reference interval.

[Nurse-managed clinic provides a good foundation for heart failure patients]. / Sjuksköterskeledd mottagning ger goda förutsättningar för hjärtsviktspatienten.

We report one of the first analyses of modern heart failure treatment in clinical practice, using beta-blockers and ACE-inhibitors, based on computerised evaluation of a nurse-administered outpatient clinic. One hundred thirty-three patients were treated. Up-titration of an ACE-inhibitor was performed in 104 patients, 13% of whom had to discontinue treatment due to intolerance. Beta-blockers were introduced in 42 patients, and 2% had to discontinue. Of those continuing therapy 97% and 89% of the targeted dose was reached, ACE-inhibitors and beta-blockers, respectively. During the titration 52% of the patients receiving an ACE-inhibitor, and 57% of those receiving a beta-blocker, reported symptomatic improvement. In contrast to pharmaceutical studies, our patients were referred with no other selection than that applied by the patient's physician. With a nurse-monitored treatment strategy it was possible to achieve a high rate of treatment compliance with ACE-inhibitors and beta-blockers.

Secular trends in sex hormones and fractures in men and women.

OBJECTIVE: To study secular trends in sex hormones, anthropometry, bone measures and fractures. DESIGN: A random population sample was studied twice and subjects of similar age group were compared 13 years apart. METHODS: X-ray-verified fractures were retrieved from a random population sample of 2400 men and women (participants 1616=67%) aged 25-64 years from the WHO, MONICA Project in Gothenburg, Sweden, in 1995 and 2008. Fasting serum hormones and calcaneal ultrasound were measured in every fourth subject. In fertile women, measurements were performed on cycle day interval 7-9. RESULTS: In 2008, men had lower serum free testosterone than men of similar age in 1995 (P<0.001). Body composition, physical activity and fracture incidence were similar. In women, hormone replacement therapy (HRT) was lower in 2008, 7 vs 28% (P<0.0001), as was serum oestradiol, although use of tranquilisers and leisure time physical activity were higher. In 2008, the fracture incidence was higher in postmenopausal women, 29 vs 17% (P<0.001), and vertebral crush had increased from 8 to 19% of all fractures (P=0.031). Serum cholesterol and triglycerides were lower in all subjects in 2008 compared with that in 1995. CONCLUSIONS: Secular trends were observed with lower serum testosterone in men in 2008, but no effect was seen on the fracture incidence of these fairly young men. In postmenopausal women in 2008, there was a higher fracture incidence along with more vertebral compressions. Lower HRT use, lower serum oestradiol and higher fall risk exposure due with more tranquilisers and leisure time physical activity in 2008 may explain the results.