Assuntos
Enterocolite Pseudomembranosa/terapia , Transplante de Microbiota Fecal , Clostridioides difficile , Úlcera Duodenal/patologia , Evolução Fatal , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hipotensão/etiologia , Hipotensão/terapia , Leucocitose/etiologia , Leucocitose/terapia , Pessoa de Meia-Idade , Choque/etiologiaRESUMO
BACKGROUND AND AIMS: Costa Rica is one of the countries with the highest incidence and mortality rates for gastric cancer. Helicobacter pylori infection rates are high in the whole country. We have previously shown that H. pylori CagA+ is significantly associated with atrophic gastritis (AG) of the antrum in a dyspeptic population. The aim of this work is to determine if other H. pylori virulence factors (vacA, dupA, oipA, iceA and babA2) are associated with atrophic gastritis (AG) or duodenal ulcer (DU). METHODS: The presence of virulence genes in Costa Rican H. pylori isolates was analyzed by PCR in 151 cultured strains from patients with dyspeptic symptoms. Endoscopic and histopathological diagnoses were available. Odds-ratio and 95% confidence intervals for AG patients vs. non-atrophic gastritis (NAG) or DU patients vs. no duodenal ulcer (NDU) patients were calculated. RESULTS: Amongst the studied isolates, 82% had the cagA+, 76.2% had the vacA s1m1, 97.0% had the oipA+, 21.0% had the icea1, 79.0% had the iceA2, 44.0% had the babA2+ and 76.0% the dupA+ genotypes. Infection with H pylori cagA+, dupA+, oipA+, iceA, babA2+, and vacA s1m1 genotypes was not associated with AG risk. The frequency of the dupA gene was 78.7 and 60.9% in isolates from patients with NDU and DU, respectively, and its presence was significantly associated with decreased risk of duodenal ulcer [odds-ratio: 0.33, pâ¯=â¯0.024, confidence interval 95% (0.11-0.85)]. CONCLUSION: H. pylori dupA genotype is inversely associated with DU risk in this population.
Assuntos
Proteínas de Bactérias/genética , Genes Bacterianos/genética , Genótipo , Helicobacter pylori/genética , Helicobacter pylori/isolamento & purificação , Fatores de Virulência/genética , Adesinas Bacterianas/genética , Antígenos de Bactérias/genética , Proteínas da Membrana Bacteriana Externa/genética , Costa Rica/epidemiologia , Úlcera Duodenal/epidemiologia , Úlcera Duodenal/etiologia , Úlcera Duodenal/microbiologia , Úlcera Duodenal/patologia , Feminino , Gastrite Atrófica/epidemiologia , Gastrite Atrófica/etiologia , Gastrite Atrófica/microbiologia , Gastrite Atrófica/patologia , Frequência do Gene , Estudos de Associação Genética , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Virulência/genéticaRESUMO
Geraniol is an acyclic monoterpene alcohol commonly used as a flavoring agent. The present study was undertaken to investigate antiulcerogenic effects of geraniol and to determine the possible mechanisms involved in this action. In the model of the ethanol-induced ulcer, treatment of rats with geraniol by oral route significantly inhibited gastric lesions by 70 % (7.50 mg/kg) to 99 % (200 mg/kg). Analysis of the gastric tissue of rats treated with geraniol (7.50 mg/kg) revealed that total glutathione content levels (GSH) increased and levels of myeloperoxidase (MPO) decreased in the gastric mucosa. Oral treatment with geraniol significantly decreased the number of ulcerative lesions induced by ischemia/reperfusion injury by 71 % and the duodenal ulcers induced by cysteamine by 68 %. The action of geraniol was mediated by the activation of defensive mucosa-protective factors such as the nitric oxide (NO) pathway, endogenous prostaglandins, increased mucus production, increased sulfhydryl compounds, antioxidant properties and the stimulation of calcitonin gene-related peptide (CGRP) release through the activation of transient receptor potential vanilloid (TRPV). The multifaceted gastroprotective mechanisms of geraniol represent a promising option for the treatment of gastric and duodenal mucosa injury.
Assuntos
Antiulcerosos/uso terapêutico , Úlcera Duodenal/tratamento farmacológico , Aromatizantes/uso terapêutico , Úlcera Gástrica/tratamento farmacológico , Terpenos/uso terapêutico , Monoterpenos Acíclicos , Animais , Antiulcerosos/farmacologia , Cisteamina , Úlcera Duodenal/etiologia , Úlcera Duodenal/patologia , Duodeno/efeitos dos fármacos , Duodeno/patologia , Etanol , Aromatizantes/farmacologia , Mucosa Gástrica/metabolismo , Glutationa/metabolismo , Masculino , Muco/metabolismo , Óxido Nítrico/metabolismo , Peroxidase/metabolismo , Piloro/cirurgia , Ratos , Ratos Wistar , Traumatismo por Reperfusão , Estômago/efeitos dos fármacos , Estômago/patologia , Úlcera Gástrica/induzido quimicamente , Úlcera Gástrica/metabolismo , Úlcera Gástrica/patologia , Terpenos/farmacologiaRESUMO
BACKGROUND: In cystic fibrosis (CF) patients a duodenal impaired bicarbonate secretion and unbuffered gastric acid are always described and the development of duodenal ulceration is uncommon (CF paradox). Helicobacter pylori (HP) infection is the main cause for duodenal ulceration and its prevalence in CF patients is controversial. AIM: The objective of this study is to evaluate HP prevalence, gastric histology, and duodenal ulceration in adult FC patients. METHODS: 32 adult CF patients were submitted to (13)C-urea breath test and serum immunoblotting test for HP diagnosis. Among them, 20 patients were submitted to endoscopy. RESULTS: 19/32 (68%) patients showed positive serology. Endoscopy showed erosive duodenitis (15%), and duodenal ulcer scar in 10%. On duodenal histology, 94.5%, showed active inflammation and 66.7% gastric metaplasia. CONCLUSION: HP infection prevalence in adult CF patients was similar to that of general Brazilian population. CF patients have all the duodenal spectrum of alterations, including duodenal ulcer. CF paradox may not exist.
Assuntos
Fibrose Cística/complicações , Úlcera Duodenal/etiologia , Duodenite/etiologia , Gastrite/etiologia , Infecções por Helicobacter/complicações , Helicobacter pylori , Adolescente , Adulto , Idoso , Úlcera Duodenal/patologia , Duodenite/patologia , Endoscopia Gastrointestinal , Feminino , Gastrite/patologia , Infecções por Helicobacter/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
This study was undertaken to evaluate the gastroprotective properties of seed, leaf, and branch methanolic extracts and guttiferone A obtained from Garcinia achachairu (Clusiaceae). Mice were used in all the models, and treatments were administered orally only in pylorus-ligated model of the extracts, and drugs were administered intraduodenally. Treatment with different extracts (500 mg/kg) significantly reduced the ulcerative lesions in the ethanol/HCl-induced model; however, the seed extract was most active. When tested in different doses (50, 250, or 500 mg/kg), the seed extract of G. achaicharu showed a dose-dependent effect with a percentage of inhibition of gastric lesions of 41, 49, and 85 %, respectively. The seed extract also significantly reduced the ulcerative lesions in the indomethacin/bethanechol-induced ulcer. In this model, the percentage of inhibition of ulcer was 24, 58, and 90 %, respectively. Regarding the model of gastric secretion, a reduction of gastric juice volume and total acidity was observed, as well as an increase in gastric pH. Considering that the seed extract was the most active, it was subjected to silica gel column chromatography, leading to the isolation of guttiferone A. The isolated compound and omeprazole were evaluated in the HCl/ethanol-induced ulcer model. In this assay, both compounds at a dose of 30 mg/kg reduced the ulcerative lesions by about 75 %. These results demonstrate, for the first time, that extracts obtained from G. achachairu and guttiferone A produce gastroprotective effects, corroborating ethnomedicinal use of this plant.
Assuntos
Antiulcerosos/farmacologia , Benzofenonas/farmacologia , Garcinia/química , Extratos Vegetais/farmacologia , Animais , Antiulcerosos/administração & dosagem , Antiulcerosos/isolamento & purificação , Benzofenonas/administração & dosagem , Benzofenonas/isolamento & purificação , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Úlcera Duodenal/patologia , Úlcera Duodenal/prevenção & controle , Concentração de Íons de Hidrogênio , Masculino , Camundongos , Omeprazol/farmacologia , Extratos Vegetais/administração & dosagem , Folhas de Planta , Sementes , Úlcera Gástrica/patologia , Úlcera Gástrica/prevenção & controleRESUMO
OBJECTIVES: To evaluate the clinical, epidemiological and endoscopic characteristics of the Helicobacter pylori (Hp) negative peptic ulcer disease. METHODS: In this cross sectional study we included 651 patients diagnosed of peptic ulcer disease between January 2000 and December 2005. The diagnosis of Hp infection was established by histology. Clinical and epidemiological characteristics of patients with and without Hp infection were compared. RESULTS: Males prevailed (69%). Hp negative ulcers were older (57.73 +/- 19.44 years old vs 50.26 +/- 18, 64 years old, P < 0.001). Clinical characteristics did not differ among both groups. Duodenal ulcer prevailed in Hp positive patients (56.5%) and gastric ulcer in Hp negative patients (53.5%). Multiple ulcers and intestinal metaplasia were more frequently found in Hp negative cases [9.3% vs 4.5% (P = 0.015) and 34.5% vs 22.1% (P = 0.001), respectively]. CONCLUSION. Hp negative peptic ulcer disease is found in older patients, with a higher frequency of gastric ulcers, multiple lesions and intestinal metaplasia.
Assuntos
Úlcera Duodenal/patologia , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Úlcera Gástrica/patologia , Idoso , Biópsia , Estudos de Coortes , Estudos Transversais , Úlcera Duodenal/epidemiologia , Úlcera Duodenal/microbiologia , Endoscopia Gastrointestinal , Feminino , Infecções por Helicobacter/epidemiologia , Humanos , Masculino , Metaplasia , Pessoa de Meia-Idade , Úlcera Gástrica/epidemiologia , Úlcera Gástrica/microbiologiaRESUMO
Tumour Necrosis Factor (TNF) and Heat Shock Protein 70 (HSP70) are important molecules in inflammatory, infectious and tumoral processes. The genes codifying these molecules are polymorphic and certain alleles have been associated with susceptibility to disease. Gastric cancer is associated with an Helicobacter pylori-induced chronic inflammatory response. The aim of this work was to analyze whether polymorphisms in inflammation-related genes are associated with the development of gastric cancer. We studied 447 Mexican adult patients including 228 with non-atrophic gastritis, 98 with intestinal metaplasia, 63 with gastric cancer and 58 with duodenal ulcer, and 132 asymptomatic individuals as well. DNA from peripheral white blood cells was typed for the Single Nucleotide Polymorphisms (SNPs) -308 of TNF-alpha, +252 of TNF-beta, +190 of HSP70-1, +1267 of HSP70-2 and +2437 of HSP70-HOM. Compared with the asymptomatic group, we found a significant association of TNF-beta*A and HSP70-1*C alleles with gastric cancer (OR 5.69 and 3.76, respectively) and HSP70-1*C with duodenal ulcer (OR 3.08). Genotype TNF-beta G/G showed a significant gene-dose effect with gastric cancer (OR 0.09); whereas HSP70-1 C/G showed significant association with both, gastric cancer (OR 13.31) and duodenal ulcer (OR 16.19). Polymorphisms in TNF and HSP70 showed a significant severity-dose-response as risk markers from preneoplastic lesions to gastric cancer in Mexican population, probably because of their association with an intense and sustained inflammatory response.
Assuntos
Úlcera Duodenal/genética , Predisposição Genética para Doença , Proteínas de Choque Térmico HSP70/genética , Lesões Pré-Cancerosas/genética , Neoplasias Gástricas/genética , Fator de Necrose Tumoral alfa/genética , Adulto , Úlcera Duodenal/microbiologia , Úlcera Duodenal/patologia , Feminino , Genótipo , Haplótipos , Infecções por Helicobacter/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Polimorfismo de Nucleotídeo Único , Lesões Pré-Cancerosas/microbiologia , Lesões Pré-Cancerosas/patologia , Fatores de Risco , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/patologiaRESUMO
BACKGROUND: Recurrence infection following successful eradication of Helicobacter pylori is usually low, except for countries with high prevalence of H. pylori. The aim of this study was to verify H. pylori recurrence rate in patients with duodenal ulcer after eradication and the possible relationship with environmental factors, histologic pattern of the mucosa and bacterial genotype. MATERIALS AND METHODS: One-hundred and ninety-four patients with an active duodenal ulcer and who were successfully treated for H. pylori infection from 1990 to 1999 were studied. A questionnaire was answered about their living conditions, and a 14C-urea breath test was performed. Patients with a positive breath test underwent an upper endoscopy to investigate for possible ulcer recurrence; gastric biopsy samples were than collected for rapid urease test and for histologic assessment. H. pylori vacA and cagA genotype was determined by polymerase chain reaction in those samples with positive urease test. RESULTS: H. pylori infection was detected in 11 patients (recurrence rate of 5.7%) that were not associated with the type of bacterial virulence. In 10 patients the ulcer was healed and all of them were clinically asymptomatic. In eight, histology showed an intensification of gastritis. All 11 patients had adequate housing and sanitary conditions and no other risk for H. pylori recurrence was identified. CONCLUSIONS: The recurrence rate of H. pylori in Brazil was higher than that reported in developed countries, but lower than usually reported in developing ones. Ulcer relapse rarely occurs even in long-term follow up.
Assuntos
Úlcera Duodenal/diagnóstico , Úlcera Duodenal/microbiologia , Infecções por Helicobacter/epidemiologia , Helicobacter pylori , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Úlcera Duodenal/patologia , Endoscopia do Sistema Digestório , Feminino , Seguimentos , Genótipo , Infecções por Helicobacter/complicações , Infecções por Helicobacter/microbiologia , Helicobacter pylori/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , RecidivaRESUMO
We investigated the topographic expression of MUC5AC and MUC6 in relationship with gastric diseases. The immunoexpression of MUC5AC and MUC6 was evaluated in 75 adults presenting Helicobacter pylori gastritis (n = 22; 11 cagA positive), duodenal ulcer (DU, n = 11), gastric ulcer (GU, n = 9), gastric carcinoma (GC, n = 20), and normal mucosa (H. pylori negative, n = 13). Five gastric areas (antral and corporeal lesser and greater curvatures and incisura) were studied. H. pylori was detected by carbolfuchsin, urease, and culture; cagA was determined by PCR. All patients with DU (eight with GU and 13 with GC) were H. pylori-positive. In H. pylori gastritis, MUC5AC expression was higher in the antrum than in the corpus; no difference was observed with respect to cagA status. MUC5AC expression was higher in the antrum of gastritis than in DU, and it was lower in the incisura among GU patients compared to DU. MUC6 expression was higher in the antrum of H. pylori gastritis compared to DU and to uninfected patients. No difference was observed in the topographic pattern of expression of MUC5AC and MUC6 among GC cases. The topographic over- and under-expression of mucins in H. pylori-associated gastritis and peptic disease suggest a role for these mucins in the pathogenesis of H. pylori infection and associated diseases.
Assuntos
Mucosa Gástrica/metabolismo , Infecções por Helicobacter/metabolismo , Helicobacter pylori/patogenicidade , Mucinas/metabolismo , Adenocarcinoma/metabolismo , Adenocarcinoma/microbiologia , Adenocarcinoma/patologia , Antígenos de Bactérias/genética , Antígenos de Bactérias/metabolismo , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Úlcera Duodenal/metabolismo , Úlcera Duodenal/microbiologia , Úlcera Duodenal/patologia , Mucosa Gástrica/anatomia & histologia , Mucosa Gástrica/patologia , Gastrite/metabolismo , Gastrite/microbiologia , Gastrite/patologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/patologia , Helicobacter pylori/isolamento & purificação , Helicobacter pylori/metabolismo , Humanos , Imuno-Histoquímica , Mucina-5AC , Mucina-6 , Reação em Cadeia da Polimerase , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/microbiologia , Neoplasias Gástricas/patologia , Úlcera Gástrica/metabolismo , Úlcera Gástrica/microbiologia , Úlcera Gástrica/patologia , Urease/metabolismoRESUMO
OBJECTIVE: To evaluate clinical and histological features of duodenal ulcer in children and adolescents. METHODS: Forty-three children with duodenal ulcer were prospectively and consecutively evaluated in a 6-year period (7.2 patients per year). Evaluation included clinical questionnaire focused on dyspeptic symptoms, physical examination, and digestive endoscopy with gastric biopsies for histological examination and Helicobacter pylori detection. RESULTS: Diagnostic age ranged from 4 years and 8 months to 17 years and 4 months (mean age: 12 years and 4 months). Abdominal pain was the main symptom (39/43, 90.7%), which was epigastric in 31/39, periumbilical in 7/39, and nocturnal in 27/39. Other symptoms were loss of appetite (32/43, 74.4%), vomiting (30/43, 69.8%), postprandial fullness (23/43, 53.5%), weight loss (22/43, 51.2%), and abdominal tenderness (19/43, 44.2%). Upper gastrointestinal bleeding occurred in 19/43 (44.2%), whereas anemia occurred in (21/43, 48.8%). Helicobacter pylori infection was detected in 41/43 (95.3%). All infected patients presented acute chronic gastritis in antrum, with lymphomononuclear infiltrate predominance in 92% of them. Eradication of the bacterium occurred in 68.3%. Ulcer healing occurred in all eradicated patients and in 89% of non-eradicated patients. CONCLUSION: Duodenal ulcer was associated with chronic gastritis due to Helicobacter pylori in the majority of patients. Many complications occurred, especially upper digestive bleeding.