gastrins and Duodenitis

Topics: Analgesics; Blood Group Antigens; Diet; Duodenitis; Gastric Acid; Gastric Mucosa; Gastrins; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Metaplasia; Peptic Ulcer; Risk Factors; Smoking; Stress, Physiological; Twin Studies as Topic

Although Helicobacter pylori is now accepted as the major aetiological factor in chronic gastritis in man, many of the factors which determine its pathogenicity are unknown. The organism has adapted to survive in the low-pH environment of the stomach, partly through its ability to buffer hydrogen ion by the hydrolysis of urea and by the presence of lectins on its surface, which bind to gastric mucosa and epithelial cells. After attachment, harmful toxins and enzymes have access to the gastric cells and cellular damage and an immune response ensues. In patients with duodenal ulceration, Helicobacter pylori-related gastritis predominantly affects the gastric antrum and has a high prevalence. Excessive gastrin production has been suggested as a potential aetiological factor linking infection with duodenal ulcer development. Perhaps more important is the association between gastric metaplasia of the duodenal epithelium, which is correlated with acid load and is more extreme in H. pylori positive patients with duodenitis. Organisms may subsequently spread from the gastric antrum into areas of gastric metaplasia in the duodenal bulb, leading to areas of chronic duodenitis and ultimately frank ulceration. It should not be overlooked, however, that other factors such as genetic predisposition, blood group, stress, drugs and smoking all have a role to play in the outcome, given the comparatively small number of patients in the general population infected with H. pylori who develop ulcer disease.

Topics: Duodenal Ulcer; Duodenitis; Duodenum; Gastric Mucosa; Gastrins; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Hydrogen-Ion Concentration; Intestinal Mucosa

The aim of this study was to determine serum gastrin levels and gastroduodenal lesions in children with chronic renal failure (CRF) on continuous ambulatory peritoneal dialysis (CAPD).. A total of 19 patients (mean age: 11.7±3.9 years, M/F: 1.37) with CRF on CAPD and 20 age-matched and sex-matched patients (mean age: 10.2±1.4 years, M/F: 1.5) with peptic ulcers were included in the study. Serum gastrin, creatinine, phosphate, and parathormone levels were determined. Upper gastrointestinal endoscopy was performed in all patients.. The basal gastrin concentrations of CAPD patients were significantly higher than those of patients with peptic ulcer disease without CRF (124.2±59.1 and 53.0±9.4 pg/ml, respectively) (P<0.001). A significant correlation was found between age, duration of uremia, and serum gastrin levels (r=0.59, P<0.01; r=0.60, P<0.01, respectively). No correlation was found between the duration of CAPD and serum gastrin levels in the patient group. Of the patients, 73.6% had abnormal upper gastrointestinal endoscopic findings. The gastroduodenal lesion observed was hemorrhagic gastritis (31.5%), followed by hemorrhagic gastroduodenitis (26.3%), gastric nodular gastritis (10.5%), and polyps (10.5%).. On the basis of our findings, such as higher serum gastrin levels in patients with CRF than those of the control group and the frequent endoscopic findings of gastroduodenal lesions in most of the patients, we recommend that an endoscopic examination should be considered for all the children with CRF on CAPD awaiting renal transplantation even if they are asymptomatic.

Topics: Adolescent; Case-Control Studies; Child; Child, Preschool; Creatinine; Duodenitis; Endoscopy, Gastrointestinal; Female; Gastrins; Gastritis; Humans; Incidence; Intestinal Polyps; Kidney Failure, Chronic; Male; Parathyroid Hormone; Peritoneal Dialysis, Continuous Ambulatory; Phosphates

A 26-year-old man was admitted to hospital with a 6-month history of diarrhea and abdominal pain. Before admission, upper and lower gastrointestinal endoscopy had shown a mild erosive duodenitis and the patient was started on a proton pump inhibitor. Physical examination and laboratory tests on admission were not constructive. In addition, repeated gastrointestinal endoscopy, cross-sectional imaging and neuroendocrine markers did not point to a specific etiology. Therefore, as a provocation test, the proton pump inhibitor therapy was discontinued. Discontinuation resulted in a progression of the patient's symptoms and an endoscopic detection of duodenal ulcers. Except for the normal serum gastrin levels, this constellation was suggestive of a gastrinoma, so that further investigations were initiated. Subsequently, the diagnosis could be confirmed and the gastrinoma located. After successful pancreaticoduodenectomy, the patient was symptom-free.. As part of a systematic investigation on chronic diarrhea, the work-up for neuroendocrine causes can play an important role. In this context, it should be kept in mind that some gastrinoma patients present without an elevation of serum gastrin levels. Regardless of a negative gastrin test, a typical symptom constellation should therefore prompt further investigations.

Topics: Abdominal Pain; Adult; Chronic Disease; Diagnosis, Differential; Diarrhea; Duodenal Ulcer; Duodenitis; Follow-Up Studies; Gastrinoma; Gastrins; Gastroscopy; Humans; Lymphatic Metastasis; Male; Pancreatic Neoplasms; Pancreaticoduodenectomy

Studies in 45 cryolite production workers (facing chronic gastritis and gastroduodenitis) demonstrated that the diseases in them have moderate inflammatory activity, atrophy of gastric lining contaminated with Helicobacter pylori, hypergastrine mia, hypopancreozymine mia and hyposecretine mia in half of the examinees.

Topics: Adult; Duodenitis; Female; Fluorine Compounds; Gastrins; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Occupational Diseases; Occupational Exposure

Topics: Aged; Biomarkers; Biopsy; Diagnosis, Differential; Duodenal Ulcer; Duodenitis; Endoscopy, Gastrointestinal; Female; Follow-Up Studies; Gastrins; Humans; Intestinal Mucosa; Risk Factors

As a result of a complex survey of 120 patients with erosive gastroduodenal affections, significant abnormalities of the aggressive-protective balance of the mucous coat of the stomach were discovered. In addition to affections of local protection factors, the change of the hormonal status characterized by hypercortisolemia, hyperinsulinemia, hypergastrinemia and increased level of such cyclic nucleotides as cAMP and cGMP was revealed. The dependence of the mucus-producing function, lysozyme activity and acid production on the level of blood hormones was discovered. Alternate dependencies of cortisol, insulin and gastrin levels on cAMP and cGMP levels as well as alternate impact of cAMP and cGMP on acid-producing gastric cells were established.

Topics: Adenylyl Cyclases; Adolescent; Adult; Aged; Cyclic AMP; Cyclic GMP; Duodenitis; Duodenum; Female; Gastrins; Gastritis; Guanylate Cyclase; Hormones; Humans; Hydrocortisone; Insulin; Male; Middle Aged; Stomach

The effects of acid, infectious (Helicobacter pylori) and neuroendocrine factors on the course and outcome of chronic duodenitis were studied in 57 patients aged 15-35 years. Within 5-year follow-up ulcer emerged in 26% of duodenitis patients. Ulceration occurred as a result of high acid production in the basal and stimulated phases, contamination of pyloric-antral mucosa with Helicobacter pylori, unbalance of serum hormones T4, TTH, FSH, ACTH. In risk of ulcerogenesis there were psychological shifts with appearance of pathological reaction to the disease. Consideration of pathogenetic specificity of different duodenitis forms and basing on objective and subjective criteria allow identification of ulcer risk group and early start of optimal therapy.

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Chronic Disease; Duodenal Ulcer; Duodenitis; Follicle Stimulating Hormone; Follow-Up Studies; Gastric Acid; Gastrins; Helicobacter Infections; Helicobacter pylori; Humans; Male; Risk Factors; Stomach; Thyroid Hormones; Time Factors

The prevalence of peptic ulcer in cirrhotic patients is similar to that reported for the general population. Although gastric acid outputs ar normal or lower in cirrhotic subjects compared with non-cirrhotics, the frequency of non-response to histamine H2-receptor antagonists is higher. Peptic ulcer disease in the cirrhotic seems to pursue a more virulent course compared with that in the non-cirrhotic subject. Peptic ulcer prevalences in patients dying of uraemia or in uraemic patients on maintenance dialysis treatment are comparable with those in the general population. However, the frequency of peptic ulcer, especially complicated ulcer, is increased following renal transplantation. Ulcer complications in this context are associated with a high mortality rate. Pre-transplant risk factors for subsequent development of peptic ulcer remain to be identified and the value of histamine H2-receptor antagonists in prophylaxis is as yet unproven.

Topics: Duodenitis; Gastric Acid; Gastric Mucosa; Gastrins; Gastritis; Humans; Kidney Failure, Chronic; Liver Cirrhosis; Peptic Ulcer; Peptic Ulcer Hemorrhage; Uremia

Chronic nonspecific bulbitis (CNB), the number of G-cells in the antrum and the level of serum gastrin were unrelated in a group of 24 patients. Gastrin may be produced by cells outside the antrum or by a few but hyperactive antral G-cells.

Topics: Chromaffin System; Duodenitis; Duodenum; Enterochromaffin Cells; Gastrins; Humans; Pyloric Antrum

Morphofunctional studies of parietal and gastrin-producing cells in 30 children with chronic gastroduodenitis with (10 patients) or without (20) recurrent erosions in the pyloroduodenal region showed functional inhibition of G cells and hyperplasia of P cells in the antral part of the stomach in children with recurring erosions. In these children, the increased surface area and density of parietal cells, the increased perimeters of secretory canaliculi's membranes, and the consequent elevated gastric juice acidity were probably due to P-cell hyperplasia in the gastric antrum and G-cell hyperplasia in the duodenal bulb. In children, gastroduodenitis with recurrent erosions should be considered a pathogenetic variant of duodenal ulcerous disease.

Topics: Adolescent; Biopsy; Child; Chronic Disease; Duodenitis; Duodenum; Female; Gastric Mucosa; Gastrins; Gastritis; Humans; Male; Microscopy, Electron; Parietal Cells, Gastric; Recurrence

It is argued that all chronic gastroduodenal peptic ulcers result from localised increase in mucosal susceptibility to acid attack at the interface between a segment of gastroduodenitis and gastric fundus or duodenal mucosa. The site is predetermined by the background mucosal pattern. Changes can occur in the differentiated gastroduodenal mucosa that closely resemble cell population transformations described in embryology and regeneration biology. A second pathological process, gastroduodenitis, may develop that does not of itself predispose to ulceration, but the combination of factors can produce a zone of increased acid susceptibility. These complex changes could be generated by immunologically activated gastroduodenitis. Destructive or stimulatory immune reactions, analogous to those seen in the thyroid gland, could affect the gastrin-secreting G cells and other paracrine cells. The resulting tropic and inflammatory reactions would provide the background for peptic ulceration.

Topics: Autoantibodies; Chronic Disease; Duodenitis; Duodenum; Gastric Fundus; Gastric Juice; Gastric Mucosa; Gastrins; Gastritis; Humans; Intestinal Mucosa; Parietal Cells, Gastric; Peptic Ulcer; Zollinger-Ellison Syndrome

Topics: Adolescent; Adrenocorticotropic Hormone; Child; Chronic Disease; Duodenitis; Gastric Juice; Gastrins; Gastritis; Growth Hormone; Histamine; Humans

Topics: Adolescent; Adult; Duodenal Ulcer; Duodenitis; Female; Gastrins; Gastroenteritis; Hormones; Humans; Insulin; Male; Middle Aged; Pituitary Hormones, Anterior; Thyroxine

Acid secretory behavior as well as gastrin levels were evaluated in 38 cases of chronic duodenitis. Basal HCl secretion was normal in 39% of cases, hypochlorhydria was observed in 29%, and hyperchlorhydria in 32%. Maximal acid output was normal in 71% of patients with duodenitis, decreased in 19%, and increased in 10%. Fasting serum gastrin was always within normal limits. The secretory behavior correlated with age but not with the histological pattern of duodenal mucosa. In chronic duodenitis, normal secretion or hypochlorhydria is the prevailing finding. This does not exclude the possibility of a peptic pathogenetic mechanism which could be involved in the rare cases of chronic duodenitis with hyperchlorhydria. Acid-peptic disease is not etiopathogenetic in the causation of most cases of chronic duodenitis.

Topics: Adult; Aged; Chronic Disease; Duodenitis; Female; Gastric Acid; Gastrins; Humans; Male; Middle Aged; Monoamine Oxidase

A clinical, endoscopic, and histological study of 206 cases of nodular hyperplasia of Brunner's glands was carried out. Firm nodules with a reddened surface due to hyperplastic Brunner's glands were limited mainly to the first part of the duodenum and affected almost exclusively male patients. Gastric acid secretion after pentagastrin stimulation was significantly increased compared to normal. In most cases, biopsies of the nodule center revealed spreading of Brunner's glands from within the lamina propria to the surface epithelium, whereas in biopsies performed between nodules, Brunner's glands were limited to the deeper part of the mucosa. Thirty-six nodules completely removed by diathermy were composed almost entirely of Brunner's glands. The frequent association with duodenal ulcer, chronic gastric erosions, and cobblestone pattern of the gastric body mucosa, as well as the significant hypersecretory state, suggest that hyperacidity plays a role in the pathogenesis of nodular hyperplasia of Brunner's glands.

Topics: Biopsy; Body Weight; Brunner Glands; Duodenitis; Duodenoscopy; Duodenum; Gastric Acid; Gastric Mucosa; Gastrins; Humans; Hyperplasia; Male

Measurements of basal and stimulated gastric acid secretion, serum gastrin, and serum pepsinogen I cannot replace direct radiologic and endoscopic examination of the gastroduodenal mucosa for diagnosis of peptic ulcer disease, or histological examination for classification of gastritis and duodenitis. These tests, however, can provide information about the functional status of the gastric mucosa and sometimes indicate the etiology of gastric acid hypersecretion. The most diagnostic combination of tests comprises markedly increased fasting serum gastrin, positive serum gastrin response to secretin challenge, and increased levels of basal acid secretion and serum pepsinogen I found in patients with gastrinoma. The same combination of results, except for negative response to secretin and marked stimulation of gastrin by food, is found in patients with antral gastrin cell hyperfunction. Increased serum gastrin concentrations often are found in patients with hyposecretion of gastric acid, including those with atrophic gastritis, and in patients with renal failure, or previous vagotomy. Patients with atrophic gastritis have a low serum pepsinogen I level, while an increased level is found with renal failure and a normal level is found after vagotomy. Thus, the concurrent measurement of serum pepsinogen I and creatinine provides a useful initial step in the evaluation of hypergastrinemia.

Topics: Creatinine; Duodenitis; Gastric Acid; Gastrins; Gastritis; Humans; Pepsinogens; Peptic Ulcer; Radioimmunoassay; Secretin

Topics: Child; Chronic Disease; Duodenitis; Fasting; Feeding Behavior; Female; Gastrins; Gastritis; Humans; Insulin; Male; Peptic Ulcer; Time Factors

Topics: Duodenitis; Esophagitis, Peptic; Female; Gastrins; Gastritis; Humans; Male; Peptic Ulcer; Postgastrectomy Syndromes; Stomach Diseases; Stomach Neoplasms