H. pylori IgG levels and the occurrence of peptic ulcer disease and non ulcer dyspepsia

H. pylori IgG levels and the occurrence of peptic ulcer disease and non ulcer dyspepsia

April 1 9 9 5 • Esophageal, Gastric, and Duodenal Disorders CLEARING FUNCTION OF THE UPPER ESOPHAGEAL SPHINCTERTHE GRABBER. P Poudemux, PJ. Kahrila...

155KB Sizes 0 Downloads 25 Views

April 1 9 9 5



Esophageal, Gastric, and Duodenal Disorders

CLEARING FUNCTION OF THE UPPER ESOPHAGEAL SPHINCTERTHE GRABBER. P Poudemux, PJ. Kahrilas. Depamnent of Medicine, Northwestern University, Chicago, IL Upper esophageal sphincter (LIES) mechanics during swallowing involves sequenced elevation, relaxation, opening, closure, and descent. The orad motion the sphincter obliterates the laryngeal vestibule as the deglutitive pharyngeal contraction clears the pharynx. This study aimed to quantify deglutitive pharyngeal clearance force on a solid bolus. Methods. Studies were done on 8 young volunteers. The LIES was localized with a station pull through using an orally passed strain gauge pressure transducer. The strain gauge was then replaced with a transducer that measured axial pull, or traction force, on small (6 mm) or large (8 ram) nylon balls screwed to its tip. Experiments were done with the baUs positioned fluoroscopically in the cervical esophagus, the UES, at the maximal deglutitive LIES orad excursion, and in the oropharynx. Three swallows were obtained at each location and recorded on a computer polygraph during concurrent videofluoroscopy synchronized to the polygraph with a videotimer. Results. The force signal developed with approach of the pharyngeal clearing wave on the ball and was of greater amplitude with the larger ball at all sites (p<0.01). The amplitude of the traction force signal was greatest within the LIES excursion area. The duration of the traction force signal also increased with proximity to the LIES such that a sustained pull (4.34+0.47s), associated with intense discomfort, was recorded with the ball just proximal to the resting position of the UES. This sustained pull occurred with the ball trapped within the sphincter during laryngeal descent and is reflected by the area under the curve (AUC) of the traction force signal (Table). Ball Location Amplitude ( ~ m s ) AUC (gram-seconds) Small Ball Large Ball Small Ball Large Ball Oropharynx 14.0i-_1.6 20.6+2.7 2.4+0.4 3.4+0.6 UES-max excursion 33.2+4.4* 73.3+7.84 3.4!-0.5" 26.2+4.6* UES-rest 38.0+2.0* 86.4+8.1" 66.1+8.7" 144.7+22.4" Esophagus 5.4+0.6 11.0-£--1.6 5.3~0.8 11.0!--1. * p<0.05 vs oropharynx and esophagus All values mear~+SE Conclusions: 1) Clearance force on a solid bolus within the excursion range of the LIES results from both the propagated pharyngeal contraction and laryngeal descent resulting in a propulsive force 3-5 times the amplitude seen in adjacent esophagus or oropharynx, 2) The presence of a foreign body within the UES during swallow induces a high amplitude reflexive contraction associated with intense discomfort, 3) The combination of UES reflexive contraction and descent act to grab and trap residual foreign bodies in the hypopharynx that would be potentially aspirated after swallowing.

H. P Y L O R I IgG- LEVELS A N D THE O C C U R R E N C E OF PEPTIC U L C E R DISEASE A N D N O N U L C E R DYSPEPSIA. V.M.Prasa& A.F.Cutier. Depts. of Gastroenterohigy, Henry Ford Hospital & Sinai Hospital, Detroit, MI. INTRO : /~ pylori(HP) infection is associated with peptic ulcer disease (PUD). Its association with non ulcer dyspepsia(NUD) remains tmclear. AIM : To determine the utility of liP IgG levels in predicting the occurrence of PUD or NUD in HP infected individuals. METHODS : We reviewed our HP data base for patients who underwent EGD and had positive liP lgG serology. Endoscopic diagnoses included DU, GU, NUD and others. NUD was defined as dyspeptic symptoms for one month with normal EGD. HP IgG serology was determined by ELISA (Pylori Star, Bin Whittaker, lnc) and expressed as absorbance. A predicted IgG index value of> 1.0 was defined as seropositive. Unpaired two-C.ailedStudent's ttest was usedto compare lgG levels in: 1) PUD vs no PUD, 2) PUD vs NUD, 3) DU vs GU, and 4) DU vs no DU. Absorbance was expressed as mean + standard deviation. RESULTS : 175 lip seropositive patients(100 M/75 F) met the review criteria (70 DU, 40 GU, 35 NUD and 30 others). Mean age for all patients was 55.4 + 15.4 years. Mean IgG level was 3.01 _+1.58(minimum 1.02, maximum 9.13).

I i

PUD vs GROUP ' t ~ P / no PUD_ ]

no PUD MEANIgG 2.98±1.48 3.06 ± 1.75

J

DU vs GU J GU

[

2.90 + 1.41 3.11 + 1:61

PUD vs NUD ~gG Pu~U.D~ 2.98 _+1.48 NUD I 2.95_+1.66 [

~

DGU DU vs no DU __ OUP. MEAN IgG 2.90 ± 1.41 -

Statistical analysis did not reveal any relationship between quantitative lgG serology and endoscopic diagnoses(all p > 0.05) CONCLUSION : HP IgG levels cannot predict the occurrence of peptic ulcer disease or non ulcer dyspepsia in HP seropositive patients.

A195

~ I C A C Y AND ~ OF LANSOPP~KZ(~ 15 M O OAD OR 30M~ OAD AS O ~ ~ T ~ A % X M ~ FOR ~ O S I V ~ ~ gSO~ZTXS. A P ~ O M Z 2 ~ ) TP.T.%L.

T POYNARD(1),JL STAUB(2),M L~lv~{EZ(3),M DELTS~qRE(4)(C. REKACEVICZ (s), V SALLER/N (6) end mul ticentric groL~. (i)Piti~ [email protected]~re Hospital, pARIS, FRANC~, (21NIORT (79) ; (3}9~NTAINEBLEAU (77), (4)HopUniv Brugmann , BRUSSELS, BELGIUM, (5)Quanta Medical, RUEIL (92), (S)Laboratoires HOUDE, ~ {92). Spontaneous relapse of reflux essphagitis occurs in 70-90% in the year after healing and the possible evolutic~% of the disease towards ccmplicati~n leads to ccmsider maintenance treatment. ~ p ~ Q ~ : 206 patients with a peptic essphagitis grade If, III or IV (Savmry Miller) end resistant to H 2 antagc~lists were included in a trial with 3 ccr~secutive periods :llopen two ~ t h s period with lansoprazole 30m~ oad. 2)healed patients were randomized ~n a double blind period of one year: lanscprazole 15mg cad (lanso 15) ,versus lansoprazole 30m~ oad (lanso 30). 3) 3 mcaaths post treatment monitoring. Patient 's evaluatien ccr~isted in endoscopy with 4 fundic biopsies (for ECL ~ t i c ~ l ) and in biological tests including gastrinernia at the beginning and at the end of the open period, at 6 end 12 mc~ths of the maintenance period, then at the end of the ~rial. Endoscopic relapse rates were evaluated by survival curves analysis. Results : 88% of patients were healed at t h e end of the open period end were included in the randomized period (ie 99 in the lanso 15 group and 85 in the lanso 30 group. At the end of the year endoscopy relapse rates were 13,4% in lanso 15 group and 10,5% in the lanso 30 group (p=0,49; NS). Relapse ra~es during the 3 months post treatment period were 60% and 64% in lanso 15 end lanso 30 group respectively. Diarrhea occured in Ii patients in whom i0 were treated with la~so 30. Plasma gastrin level remained normal in 78% of patients of lanso 15 group and 80% of patients in lanso 30 group. Cne patient (lanso 15) presented with a micronodular hyperplasia of fundic ECL cells after cne year. There was no case of ECL cell dysplasia. : Lansoprazole (15rag or 30m~) was very effective in preventic[l of esophagitis relapses with a slight advantage in term of clinical tolerance (diarrhea) in the 15rag groilp.

• I'L PYLORI lgG SEROLOGY F O L L O W I N G SUCCESSFUL E R A D I C A T I O N - FOUR YEAR FOLLOW-UP. V.M. Prasad P. Santogade, A.F. Cutler. Depts. of Gastroenterology, Henry Ford Hospital & Sinai Hospital, Detroit, MI. We have previously shown that 1) specific ALpylori (liP) IgG serology decline after lip eradication, 2) a 20% reduction in HP IgG serology at one year predicts eradication with a sensitivity of 88% and 3) the mean reduction in HP IgG serology 21 months post eradication is 48%. However, I-IP IgG serology pattern beyond 21 months after eradication remains unknown. We determined the HP IgG serology pattern four years after successful HP eradication. METHODS: 29 patients, who were successfully treated for I-IPwith triple therapy (metronidazole, tetracycline and bismuth subsalicylate) during 1990-91 and had the baseline serum frozen, consented to have follow-up serum collected. A simultaneous 30 minute [13C]urea breath test was done to confirm HP infection status for each patient. Serology was determined by ELISA (Pylori Stat, Bin WhittakeL Inc) and expressed as absorbance. The baseline and follow-up eera for a given patient were analyzed in a single run. Baseline HP infection was defined as the presence of the organism in antral biopsies by Warthin Starry(WS) staining and a positive [13C]urea breath test. Eradication after triple therapy was defined as the inabilityto identify the organism by WS staining and a negative [13C]uren breath test 6 weeks post treatment.

RESULTS: All 29 patients continued to be free of liP and demonstrated a decline in their follow-up IgG serology from baseline. Years id~¢£ treatnlent

Serology decline >_ 29~

2.7 to 4.4 (mean 3.5)

27/29 (93%)

~ serolog:~ 51%

Sere (+) to sere (-~ ~nversina 8/29 (28%)

CONCLUSION: The overall mean decline in HP lgG serology four years post treatment was 51% More than 70% of successfully treated patients continue to remain HP seropositive four years post treatment A 20% decline in lgG serology established PIP eradication with an overall sensitivityof 93%.