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Prevalence of Helicobacter pylori infection in the elementary school students and their parents in Korea
A72
AGA ABSTRACTS
• BLEEDING PEPTIC ULCER: INJECTION OF ADRENALINE OR TISSUE ADHESIVE (HISTOACRYL). C.P.Choudari & K.R.Palmer. G.I.Unit, Western General Hospital, Edinburgh, Scotland. Permanent haemostasis is achieved by endoscopic injection with dilute adrenaline in most patients who Present with peptic ulcer bleeding. Failed haemostasis occurs in 15% of cases, presumably because the bleeding artery remains patent. In experimental animals neither adrenaline nor a range of sclerosants caused arterial thrombosis and in a clinical trial combination injection therapy with adrenaline and ethanolamine was no more effective than adrenaline alone. The tissue adhesive histoacryl solidifies instantly in blood and causes arterial thrombosis; it appears to be an ideal agent for bleeding peptic ulcer injection therapy. Methods: 249 patients underwent emergency endoscopy for acute gastrointestinal haemorrhage. Sixty eight of these presented with arterial peptic ulcer bleeding or a non-bleeding visible vessel within an ulcer and were randomised to endoscopic injection with 3-10 mls 1:100,000 adrenaline (36 patients) or to 0.5 mls of a mixture of histoacryl and lipiodol
(5:8). Results: The two groups were well matched. Three patients in the adrenaline group and 2 in the histoacryl group rebled. Operation rates (2 and 1 patient), median transfusion requirements (4.0 and 3.5 units) and median hospital stay (9 and 7 days) were similar. No acute complications occurred. Conclusions: Both adrenaline and histoacryl are effective agents for bleeding ulcer. Adrenaline remains the treatment of choice because of greater simplicity and lower cost.
PREVALENCE OF HELICOBACTER PYLORI INFECTION IN THE ELEMENTARY SCHOOL STUDENTS AND THEIR PARENTS IN KOREA. IS Chung, SH Oh, JK Kim, SJ Kim, SH Park, MG Choi, HS Sun, DH Park, BS Kim. Dept. Internal Medicine, Catholic University Medical College, Seoul, Korea Helicobacter pylori infection is associated with development of gastric cancer, particularly in children. Considering the high incidence of gastric cancer in Korea, studying the prevalence of H. pylori and evaluating the influencing factors associated with H. pylori infection in Korean children is considered important. We evaluated prevalence of H. pylori infection in 187 elementary school stu~tents(age: 6 - 11 years) and 87 their parents(age: 28 - 65 years) in both rural and urban areas with IgG specific antibody for H. pylori. Prevalence of H. pylori infection in elementary sc'hool students and their parents was 26.5% and 69.2% respectively (P
GASTROENTEROLOGY, Vol. 108, No. 4
RISK OF POST-OPERATIVE DEATH IS HIGH AFTER FAILED ENDOSCOPIC THERAPY FOR BLEEDING ULCER. C.P.Choudari & K.R.Palmer. G.I.Unit, Western General Hospital, Edinburgh, Scotland. We examined the hypothesis that patients who continue to bleed or rebleed from peptic ulcer despite endoscopic treatment are at particular risk of post-operative death because of delays in a defmite surgical operation. Post-operative mortality was recorded in 227 patients (group 1) who underwent urgent surgery for peptic ulcer haemorrhage between Jan 1985 and Dec 1988, when endoscopic therapy was unavailable. This was compared to the post-operative mortality of 50 patients who underwent a similar range o f surgical operations for bleeding ulcer following the failure of endoscopic treatment (group 2). This group was derived from a total of 342 patients in whom endoscopic injection or heater probe therapy was attempted for ulcer bleeding over the period June 1990 April 1994. All patients receiving endoscopic therapy had either active arterial bleeding or a non-bleeding visible vessel. The overall mortality of the 342 patients in whom endoscopic therapy was attempted was 5%. Post-operative mortality in group 1 was 12%, compared to 22% in group 2 (p<0.05). Seven group 2 patients rebled after surgery; four of these died. The mortality of patients treated endoscopically for bleeding ulcer is low. The high post-operative mortality of group 2 may be either due to endoscopy related delay in surgery or to the probability that this group had sustained more severe haemorrhage than that of group 1 patients. The challenge remains identification of the patient subgroup who are destined to fail endoscopic therapy and who should undergo urgent surgery.
H2 ANTAGONISTS STIMULATE PROLIFERATION, BUT NOT MIGRATION, OF HUMAN GASTRIC MUCOSAL CELLS IN VITRO THROUGH A TGF ALPHA, EGF RECEPTOR mRNA SYNTHESIS I N D E P E N D E N T PATHWAY. C Ciacci,* R Zarrilli,** V Ricci,@ A De Luca, M Romano, R J ~ e y , # . Dept of Medicine, II
U n i v of Naples, Italy, *GI S e c t i o n and * * D e p t of Molecular and Cell Biology, Federico II Univ, Naples, I t a l y , @ D e p t of Physiology, Univ of Pavia, Italy, #Dept of Medicine GI, Vanderbilt Univ, Nashville, TN, USA. Mucosal repair involves migration of viable cells from areas a d j a c e n t to the i n j u r e d s u r f a c e and replacement of lost cells by cell division. ~ I S : the ulcer h e a l i n g effect of H2 a n t a g o n i s t s m a y be c o n t r i b u t e d to by s t i m u l a t i o n of m i g r a t i o n a n d / o r proliferation of gastric cells. AIMS: to assess whether i) the H 2 a n t a g o n i s t s roxatidine (E0X) or ranitidine (RAN) affect gastric cell migration and/or proliferation using an e x p e r i m e n t a l model Where s y s t e m i c factors and i n h i b i t i o n of g a s t r i c a c i d s e c r e t i o n are e x c l u d e d ( E o m a n o e t a l , Gut 3 3 : 3 0 38,1992); 2) enhanced mRNA expression of TGF alpha and or EGF receptor (R) is involved in any such effect. METHODS: i) Cell Culture: MKN 28 cells (mucous cells from a well differentiated human gastric adenocarcinoma); 2) Cell Migration: confluent monolayers were wounded by a single edge razor blade (Ciacci et al, G a s t r o i05:9~-i0~, 1993) and t h e n incubated with R0X or RAN 10-u-10 -~ M or medium only (control) and migrating cells were counted by means of an eyepiece reticle after 24 hrs; 3~ C~II Proliferation: the ~ f e c t ~ o f EOX and RAN 10-v-10 -~ M and of TGF a l p h ~ 1 0 - ~ - 1 0 -= M was assessed by m e a s u r i n g the uptake of [OH]-Thymidine (THY) and by cell count; 4) TGF a l p h a and EGFR mRNA Expression: assessed by northern blot analysis. RESULTS: i) ROX and R A N d i d not significantly affect gastric cell migration; 2) ROX and RAN d o s e - d e p e n d e n t l y s t i m u l a t e d cell p r o l i f e r a t i o n causing a 60% increase in [~H]-THY uptake (p<0.05) and cell count (p<0.05); 3) TGF alph~ dose-dependently and significantly (50% increase in [~H]-THYuptake, p<0.05) stimulated cell proliferation; 3) ROX a n d R A N did not affect the e x p r e s s i o n of TGF a l p h a or E G F R mRNA. CONCLUSIONS: i) ROX and RAN stimulate proliferation, but not migration, of gastric mucosal calls /n vitro through a mechanism independent of TGF alpha or EGFR m R N A synthesis; 2) this e f f e c t m i g h t c o n t r i b u t e to their ulcer healing property in vivo.~
AGA ABSTRACTS
• BLEEDING PEPTIC ULCER: INJECTION OF ADRENALINE OR TISSUE ADHESIVE (HISTOACRYL). C.P.Choudari & K.R.Palmer. G.I.Unit, Western General Hospital, Edinburgh, Scotland. Permanent haemostasis is achieved by endoscopic injection with dilute adrenaline in most patients who Present with peptic ulcer bleeding. Failed haemostasis occurs in 15% of cases, presumably because the bleeding artery remains patent. In experimental animals neither adrenaline nor a range of sclerosants caused arterial thrombosis and in a clinical trial combination injection therapy with adrenaline and ethanolamine was no more effective than adrenaline alone. The tissue adhesive histoacryl solidifies instantly in blood and causes arterial thrombosis; it appears to be an ideal agent for bleeding peptic ulcer injection therapy. Methods: 249 patients underwent emergency endoscopy for acute gastrointestinal haemorrhage. Sixty eight of these presented with arterial peptic ulcer bleeding or a non-bleeding visible vessel within an ulcer and were randomised to endoscopic injection with 3-10 mls 1:100,000 adrenaline (36 patients) or to 0.5 mls of a mixture of histoacryl and lipiodol
(5:8). Results: The two groups were well matched. Three patients in the adrenaline group and 2 in the histoacryl group rebled. Operation rates (2 and 1 patient), median transfusion requirements (4.0 and 3.5 units) and median hospital stay (9 and 7 days) were similar. No acute complications occurred. Conclusions: Both adrenaline and histoacryl are effective agents for bleeding ulcer. Adrenaline remains the treatment of choice because of greater simplicity and lower cost.
PREVALENCE OF HELICOBACTER PYLORI INFECTION IN THE ELEMENTARY SCHOOL STUDENTS AND THEIR PARENTS IN KOREA. IS Chung, SH Oh, JK Kim, SJ Kim, SH Park, MG Choi, HS Sun, DH Park, BS Kim. Dept. Internal Medicine, Catholic University Medical College, Seoul, Korea Helicobacter pylori infection is associated with development of gastric cancer, particularly in children. Considering the high incidence of gastric cancer in Korea, studying the prevalence of H. pylori and evaluating the influencing factors associated with H. pylori infection in Korean children is considered important. We evaluated prevalence of H. pylori infection in 187 elementary school stu~tents(age: 6 - 11 years) and 87 their parents(age: 28 - 65 years) in both rural and urban areas with IgG specific antibody for H. pylori. Prevalence of H. pylori infection in elementary sc'hool students and their parents was 26.5% and 69.2% respectively (P
GASTROENTEROLOGY, Vol. 108, No. 4
RISK OF POST-OPERATIVE DEATH IS HIGH AFTER FAILED ENDOSCOPIC THERAPY FOR BLEEDING ULCER. C.P.Choudari & K.R.Palmer. G.I.Unit, Western General Hospital, Edinburgh, Scotland. We examined the hypothesis that patients who continue to bleed or rebleed from peptic ulcer despite endoscopic treatment are at particular risk of post-operative death because of delays in a defmite surgical operation. Post-operative mortality was recorded in 227 patients (group 1) who underwent urgent surgery for peptic ulcer haemorrhage between Jan 1985 and Dec 1988, when endoscopic therapy was unavailable. This was compared to the post-operative mortality of 50 patients who underwent a similar range o f surgical operations for bleeding ulcer following the failure of endoscopic treatment (group 2). This group was derived from a total of 342 patients in whom endoscopic injection or heater probe therapy was attempted for ulcer bleeding over the period June 1990 April 1994. All patients receiving endoscopic therapy had either active arterial bleeding or a non-bleeding visible vessel. The overall mortality of the 342 patients in whom endoscopic therapy was attempted was 5%. Post-operative mortality in group 1 was 12%, compared to 22% in group 2 (p<0.05). Seven group 2 patients rebled after surgery; four of these died. The mortality of patients treated endoscopically for bleeding ulcer is low. The high post-operative mortality of group 2 may be either due to endoscopy related delay in surgery or to the probability that this group had sustained more severe haemorrhage than that of group 1 patients. The challenge remains identification of the patient subgroup who are destined to fail endoscopic therapy and who should undergo urgent surgery.
H2 ANTAGONISTS STIMULATE PROLIFERATION, BUT NOT MIGRATION, OF HUMAN GASTRIC MUCOSAL CELLS IN VITRO THROUGH A TGF ALPHA, EGF RECEPTOR mRNA SYNTHESIS I N D E P E N D E N T PATHWAY. C Ciacci,* R Zarrilli,** V Ricci,@ A De Luca, M Romano, R J ~ e y , # . Dept of Medicine, II
U n i v of Naples, Italy, *GI S e c t i o n and * * D e p t of Molecular and Cell Biology, Federico II Univ, Naples, I t a l y , @ D e p t of Physiology, Univ of Pavia, Italy, #Dept of Medicine GI, Vanderbilt Univ, Nashville, TN, USA. Mucosal repair involves migration of viable cells from areas a d j a c e n t to the i n j u r e d s u r f a c e and replacement of lost cells by cell division. ~ I S : the ulcer h e a l i n g effect of H2 a n t a g o n i s t s m a y be c o n t r i b u t e d to by s t i m u l a t i o n of m i g r a t i o n a n d / o r proliferation of gastric cells. AIMS: to assess whether i) the H 2 a n t a g o n i s t s roxatidine (E0X) or ranitidine (RAN) affect gastric cell migration and/or proliferation using an e x p e r i m e n t a l model Where s y s t e m i c factors and i n h i b i t i o n of g a s t r i c a c i d s e c r e t i o n are e x c l u d e d ( E o m a n o e t a l , Gut 3 3 : 3 0 38,1992); 2) enhanced mRNA expression of TGF alpha and or EGF receptor (R) is involved in any such effect. METHODS: i) Cell Culture: MKN 28 cells (mucous cells from a well differentiated human gastric adenocarcinoma); 2) Cell Migration: confluent monolayers were wounded by a single edge razor blade (Ciacci et al, G a s t r o i05:9~-i0~, 1993) and t h e n incubated with R0X or RAN 10-u-10 -~ M or medium only (control) and migrating cells were counted by means of an eyepiece reticle after 24 hrs; 3~ C~II Proliferation: the ~ f e c t ~ o f EOX and RAN 10-v-10 -~ M and of TGF a l p h ~ 1 0 - ~ - 1 0 -= M was assessed by m e a s u r i n g the uptake of [OH]-Thymidine (THY) and by cell count; 4) TGF a l p h a and EGFR mRNA Expression: assessed by northern blot analysis. RESULTS: i) ROX and R A N d i d not significantly affect gastric cell migration; 2) ROX and RAN d o s e - d e p e n d e n t l y s t i m u l a t e d cell p r o l i f e r a t i o n causing a 60% increase in [~H]-THY uptake (p<0.05) and cell count (p<0.05); 3) TGF alph~ dose-dependently and significantly (50% increase in [~H]-THYuptake, p<0.05) stimulated cell proliferation; 3) ROX a n d R A N did not affect the e x p r e s s i o n of TGF a l p h a or E G F R mRNA. CONCLUSIONS: i) ROX and RAN stimulate proliferation, but not migration, of gastric mucosal calls /n vitro through a mechanism independent of TGF alpha or EGFR m R N A synthesis; 2) this e f f e c t m i g h t c o n t r i b u t e to their ulcer healing property in vivo.~