bluuebunny/crossref_metadata_2025 huggingface dataset:
HELICOBACTER PYLORI INFECTION AND THE DEGREE OF GASTRITIS IN PATIENTS WITH OSTEOARTHRITIS TREATED WITH SODIUM DICLOFENAC
Authors: Syukri Maimun , Oesman Nizam , Kusumobroto Hernomo O , Adi Pangestu , Soeroso Joewono , Soemarno Troef , Asnawati
Published: March 2003

The use of Non‐Steroid Anti Inflammation Drugs (NSAIDs) and Helicobacter Pylori (H. pylori) infection increase the risk of peptic ulcer and gastropathy, but the association between H. pylori and NSAIDs in developing gastro‐duodenal lesion remains unclear

Objective

To evaluate whether H. pylori infection increases the degree of gastritis in osteoarthritis patients treated with oral Sodium diclofenac.

Material and methods

Twenty eight patients with osteoarthritis who took Sodium diclofenac orally for more than 4 weeks in the Division of Rheumatology Dr. Soetomo Hospital ‐ Surabaya participated in this cross‐sectional study. The endoscopic evaluation was conducted in the Division of Gastroenterology in the same hospital, and the results were graded using Modified Gastroscopy Rating Scale of Lanza. Antral and gastric body biopsies were stained with Giemsa and Warthin‐Starry methods. The Sydney System was used to descibe chronic gastritis, metaplasia, gastric atrophy and H. pylori infection. The result was analyzed using Chi‐square test and any (p)=0.05 was considered significant.

Result

On endoscopic evaluation 11 (39.29%) patients had normal gastric mucosa, 5 (17.86%) patients showed 1 location of erosion while the rest 12 (42.85%) patients had more than 1 location of erosion or bleeding. H. pylori was found on 16 (57.14%) patients. Twelve (57.14%) patients out of 21 patients with dyspepsia were positive for H. pylori. H. pylori was positively identified on 9 (75%) patients with superficial chronic gastritis, 4 (50%) patients with acute gastritis, 1 (100%) patient with chronic gastritis and metaplasia, and on 2 (28.57%) patients with chronic gastritis and atrophy. When the 16 patients infected with H. pylori were graded with Lanza Scale, 7 (43.75%) patients were in grade 0.4 (25%) patients in grade 1, and the other 5 (31.25%) patients were in grade 2. On statistical analysis, we did not find any significant association between H. pylori infection and the degree of gastritis in osteoarthritis patients taking Sodium diclofenac.

Conclusion

We found that H. pylori infection did not increase gastritis degree in osteoarthritis patients who took oral Sodium diclofenac.
ULTRASTRUCTURAL CHARACTERISTICS OF HELICOBACTER PYLORI (Hp) AND OF GASTRIC MUCOSA IN PATIENTS WITH GASTRIC ULCERS BEFORE AND AFTER HP ERADICATION
Authors: Dung Trinh Tuan , Long Ta , Hop Tran Van
Published: March 2003

Objective

To determine the ultrastructural characteristics of Hp and of gastric mucosa (GM) in gastric ulcer (GU) patients before and after HP eradication.

Materials & Methods

13 cultural HP samples and 52 endoscopic biopsy specimens of GM taken from 26 GU patients before and one month after HP eradication by triple therapy (OAM) for electron microscopic examinations using negative staining, direct observation and ultrathin section methods. Analyzed by JEM 1010 transmission electron microscope.

Results

Hp were spiral GR (‐) wall, curved or S‐shapes, size of 4x0.5‐1μm with 4‐7 slender flagella at one pole, attached on endoplasmic membrane of GM cells or slipped in the slits between cells. Some HP with many Phages in the cytoplasm. Main lesions of GM cells with Hp infection were reduction or loss of microvilli, rupture of cell membrane, degeneration with formation of vocuoles in the cytoplasm, degeneration or loss of the organelles (mitochondria, secretory granules, endoplasmic reticulla), widening of nucleus membrane holes and irregular distribution of chromatins in nuclei of the cells. After Hp eradication, recuperation of GM cells were clearly observed with reappearance of microvillion on cell membrane, abundance of secretory granules and organelles in the cytoplasm, double membrane of nuclei was clearly observed.

Conclusions

1) Ultrastructurally, Hp were Gr (‐), spiral curved or S‐shaped bacteria, size of 3‐4x0.5‐1mm with 4‐7 slender flagella at one pole. 2) main lesions of GM cells with HP infection included reduction or loss of microvilli, rupture of membrane, degenerations with formation of vacuoles in cytoplasm and degeneration or loss of the organelles, 3) After Hp eradication, recuperation of GM cells was obviously.
HUMAN GASTRIC BIOPSIES CULTURED IN VITRO, AN USEFUL MODEL FOR STUDIES OF HELICOBACTER PYLORI INFLAMMATORY RESPONSES
Authors: Olfat Farzad O. , Noslund Erik , Fredman Jakob , Borén Thomas , Engstrand Lars
Published: March 2003

Objective

We have developed a unique in vitro model by culturing human biopsies to create a similar environment of the human infection. By using this method we have investigated the reaction of the tissue to exposure to different clinical isolates of H. pylori. The binding/colonization ability of some type strains and some clinical isolates was analyzed. The cytokine production of the stomach tissue was measured and analyzed with respect to time, number of bacteria and defined virulence factors.

Methods

Donut‐shaped biopsies were removed for culture, from uninfected patients who went through surgery due to obesity. The underlying tissues were removed and the epithelial cell layer was punched out into 2 mm biopsies. After adherence of biopsies to the surface, the different H. pylori strains were added to the biopsies with different adjusted pH. Using an ELISA kit, the production of IL‐8 was analyzed and Viable Count estimates were performed.

Results

The production of IL‐8 started 3‐4 hours post‐infection. This was similar for all strains analyzed. Maximal difference between strains was seen in a set of two isogenic strains, where the mutant lacks the entire cag‐PAI. Another strains which activate neutrophils, also induced IL‐8 at high level. The lowest level was observed in a strain isolated from an asymptomatic patient. However, although the IL‐8 production was different for the isogenic strains, colonization pattern didnít show such variability.

Conclusion

Our model is based on the use of the human gastric tissues, where the tissues are vital and produce mucus. These biosies are resistant to acidic conditions as low as pH 2. Our data in this series of experiments confirmed the influence of cag‐PAI in production of IL‐8. This method can be used to study bacterium‐host cross‐talk and serve as a more reliable infection model.
“Cag PAI HAVE A FUNCTION RELATED WITH ADHESION TO GASTRIC EPITHELIAL CELLS”
Authors: Mizushima Takuji , Sugiyama Toshiro , Komatsu Yoshito , Ishizuka Jun , Kumagai Ayae , Oda Hirasashi , Kagaya Hidetoshi , Hokari Kaku , Sukegawa Makoto , Saito Nagahito , Takeda Hiroshi , Asaka M.
Published: March 2003

Objective

The cag pathogenecity island (PAI) is a major virulence factor of Helicobacter pylori (H.p). Andherent ability of H. pylori to the gastric epithelial cells is an important initial step for bacterial virulance. The hpaA and bab A2 genes are thought to be major adherent‐associated genes. Some of cag genes have partial homology to the flagellar aparatus or other adhesion related gene. It is not fully investigated whether cag PAI is related with the adherent ability to the gastric epithelial cells. To evaluate the interaction between the structure of Cag PAI and adherent ability to the gastric epithelial cells.

Methods

The polymerase chain reaction (PCR) and Southern blot analysis were used to determine the structure of cag PAI in Japanese 236 clinical isolates. The PCR and Southern blot analysis were used to verity the presence or absence of hpaA and bab A2. Adherent ability H. pylori to the gastric epithelial cells (KATO cells) was examined in the tested strains by flow‐cytometric analysis (FACS) using anti‐H. pylori antibody.

Results

Seven cag PAI partial deleted strains of tested 236 strains (3.0%) were found by PCR and southern blot analysis, and which showed 3 pattern in deleted region within cag PAI. All cagG‐deleted strains showed less ability of adhesion than CagG positive strains. The peak counts of the cells adhered with cagG deleted strains ( n = 4 ) were significantly lower than that of cagG positive strains ( n = 8 ) ( mean peak count ± SE ; 27.3 ± 2.9 vs 54.8 ± 4.9 ) by FACS analysis. All of cagG‐deleted strains posessed hpaA gene. Six of them possesed babA2 gene.

Conclusions

Our results demonstrated that cagG‐deleted clinical isolates had less ability of adhesion to the gastric epithelial cells, even if hpaA and babA2 gene are present.
EVALUATION OF DYSPEPTIC SYMPTOMS AND ACID SUPPRESSIVE DRUG (ASD) CONSUMPTION IN SUCCESFULLY ERADI CATED AND HEALED DUODENAL ULCER (DU) PATIENTS; RESULTS OF A ONE YEAR PROSPECTIVE STUDY
Authors: Gy Pecsi , Szabo  , Csondes A. , P M. Abraham , I. Racz
Published: March 2003

Aim:

To determine the upper abdominal symptoms, the use of ASD and the recurrence‐rate of Helicobacter pylori in DU (Hp) patients one year after ulcer healing and successful HP eradication.

Patient and methods:

37 endoscopically proven healed and successfully eradicated DU patients were successfully recruited in the study. All patients had active ulcer and showed HP positivity both by rapid urease test and histology 5 weeks before the enrollement endoscopy. The severity and character of dyspeptic symptoms and the use of ASD‐s were checked by questionnaires at the start and one year after successful eradication therapy. NSAID users and reflux oesophagitis patients were excluded at inclusion. Eradication was performed by a one week LAC combination followed by 4 week ranitidine therapy. HP reinfection was controlled by C13 urea breath test at the 12 month visit.

Results:

7 patients were lost for follow up by the end of the one year program. A together the data of 30 eligible patients (17 females, 13 males, mean age 49 years) were analyzed. The questionnaires represent the symptoms and ASD use of the whole year program. Only 12 out of 30 patients (40%) were permanently and completely symptoms free after the cessation of the short‐term therapy. 16 patients (53.3%) had temporary and 2 patients (6.7%) had persistant symptom. About half of the patients (n=17) were taking absolutely no ASD during the follow up. The number of occasional and continuous ASD users were 7 (23.4%) and 6 (20%) respectively. HP reinfections occurred in one patient and no ulcer relaps was proven.

Conclusions:

1. More than half of the patients had clinically relevant dyspeptic symptoms during the year after successful HP eradication and ulcer healing. 2. The majority of them required occasional or long term ASD therapy in this period. 3. Recurrences rate of HP was low.
EXPRESSION OF CYCLOOXYGENASE‐2 (COX‐2) IN PRE‐MALIGNANT GASTRIC LESIONS BEFORE AND AFTER H. PYLORI ERADICATION
Authors: Leung W.k , To K.F. , Chan Francis K.L. , Go Minnie Y.Y. , Cheng Alfred S.L. , Ng Enders K.W. , Sung. Joseph J.y
Published: March 2003

Objective

COX‐2 is frequently expressed in gastric cancer, which may play a active role in carcinogenesis, tumor invasion and metastatis. To evaluate the distribution and expression of COX‐2 in various stages of gastric carcinogenesis and monitor the changes of COX‐2 in intestinal metaplasia (IM) after H. pylori eradication.

Methods

Gastric biopsies were selected from a group of H. pylori infected patients with various histological diagnosis of chronic active gastritis (CAG, n=40), gastric atrophy (GA, n=20), IM (n=51) and adenocarcinoma (CA, n=25). Non‐infected (n=40) were included as control. Expression of COX‐2 was examined by immunohistochemistry and scored in a semiquantitative manner: 0 = negative , 1 = <5% cells with positive staining, 2 = 5‐30%, 3 = 30‐60% and 4 = >60%. Cellular localization of COX‐2 was further confirmed by in‐situ hybridization of COX‐2 mRNA using an anti‐sense RNA probe. In subgroup of patients with IM, the experissions of COX‐2 one‐year after successful H. Pylori eradication was compared with pre‐treatment level.

Results

COX‐2 expressions were detected in all H.Pylori‐infected patients irrespective of histological diagnosis. In Contrast, only 14 (35%) H. Pylori‐negative control expressed weak COX‐2 expression (median score 0 vs 2; P<0.0001). However, there was no difference in the intensity of COX‐2 expression between CAG, GA, IM and CA patients. Among the 17 IM patients who had received successful H. Pylori eradication therapy, there was a modest reduction of COX‐2 expressions in both epithelial (P=0.049) and stromal cells (P=0.001) at one‐year. However, there was no significant change in the severity of IM, not any correlation between changes in IM and COX‐2 expression, at one‐year follow‐up.

Conclusion

Both premalignant and malignant gastric lesions show strong COX‐2 expression. Although successful eradication of H. pylori reduces the level of COX‐2 expression, there is no association with regression of IM at one year.
MANAGEMENT OF HELICOBACTER PYLORI INFECTION
Authors: Manan Chudahman
Published: March 2003

Background:

Some diseases of UGI, like chronic active gastritis, peptic ulcer, cancer, strongly related to H. pylori infection. Before H. pylori was found, the problem of management PU, recurrent rate was very high. This condition come from healing of PU only clinical and endoscopic findings, but the criteria of healing must be confirm by eradicate of H. pylori infection.

Aim:

To prove efficacy of some regimens to eradicate H. pylori infection.

Method:

Some samples included this study with diagnosis Chronic active gastritis, duodenal ulcer, gastric ulcer, and on laboratory findings H. pylori positive. Each group of cases got some regimens of therapy, like triple, dual quadruple therapy. The duration of treatment 2 weeks, and after that to perform the endoscopic and laboratory examination to find H. pylori infection. The data presented with descriptive analysis.

Result:

Eradication rate triple therapy (omeprazole, clarithromycin & amoxycilin), for chronic active gastritis 90‐100%, gastric ulcer and for dual therapy (omeprazole, amoxycillin, omeprazole, ceftibuten) 83.3%. Micro organism sensitivity test in vitro found that resistency for clarithromycin 18.2%, Metronidazole 90.9% and amoxycilin 31.2%.

Conclusion:

Omeprazole, Amoxycilin and Clarithromycin (triple therapy) were the drug of choice to eradicate H. pylori infection.
MULTIPLE STRAIN HELICOBACTER PYLORI INFECTION IN PATIENTS WITH DYSPEPSIA
Authors: Achwan Wenny Astuti , Muttaqin Zainul , Isnaningsih Sri , Sumoharjo Suwignyo
Published: March 2003

Objective

Some author reported that infection by more than one strain of Helicobacter pylori in the same patient is not rare. The objective of this study is to explore the possibility of multiplicity of Helicobacter pylori strain in patients with dyspepsia using Random Amplified Polymorphic DNA (RAPD) technique.

Material and Method

Upper GI Endoscopy and gastric mucosal biopsy were done on 81 patiens with dyspepsia in Endoscopy Unit Department of Internal Medicine Mataram General Hospital. Gastric Mucosal biopsy was done on three different sites of antrum. Primary culture of Helicobacter pylori was done from each biopsy specimen separately. RAPD was done by Polymerase Chain Reaction using single primer (5’AACGCGCAAC3’) on the colonies grown from secondary culture of each biopsy specimen.

Results

Helicobacter pylori can be grown in 23 patients (28.3%). Helicobacter pylori was grown from single biopsy specimen in 17 patients, while in 6 patients from 2 or 3 biopsy specimens. Heterogenity of RAPD pattern was found in 3 cases, while in the other 3 cases RAPD patterns were identical. Pattern of antibiotic sensitivity of strains found in the same patients was identical.

Conclusion:

Infection with more than one strain with different genetic pattern can be found in patients with dyspepsia caused by Helicobacter pylori infection.
PRE CANCER LESION H. pylori CHRONIC INFECTION
Authors: Yoewono Vera D. , Krinuhoni E. , Marwoto W , Widodo S.O. Sri
Published: March 2003

Recently, some studies revealed that gastric cancer and precancer, were more frequent in individuals with H. pylori antibodies.

Histological studies, found that the relationship between H. pylori infection and gastric cancer were in wide range (19% ‐ 80%).

In our department, from 1999 Jan 1st to 1999 Dec 31th

No biopsy, showed severe atrophic/dysplasia, or lymphoid follicle.

Age, ethnic and location were also studied, correlated to malignant and premalignant lesions.
Helicobacter pylori induces apoptosis in gastric epithelial cells through inducible nitric oxide
Authors: Watanabe Sumio , Takagi Atsushi , Koga Yasuhiro , Kamiya Shigeru
Published: March 2003

Background
: Gastric mucosal injury by Helicobacter pylori has been suggested to be mediated by various cytokines induced by this organism. Nitric oxide (NO) is an important effector molecule involved in immune regulation and defence. To clarify the mechanisms by which H. pylori induces gastric mucosal cell injury, we examined whether H. pylori induces gastric epithelial death via NO production.

Methods
: Cytotoxic and non‐cytotoxic strains of H. pylori were used. The death of MKN45 cells caused by H. pylori was examined by the 3‐(4,5‐dimethyl‐thiazole‐2yl)‐2,5‐diphenyl tetrazolium bromide (MTT) assays. Aminoguanidine was used to inhibit inducible nitric oxide synthase (iNOS) activity. Expression of iNOS mRNA was determined by the reverse transcriptase–polymerase chain reaction and the DNA fragmentation analysis was performed by using agarose gel electrophoresis.

Results
: The MTT assay revealed that neither viable H. pylori nor other components of the microorganism induced cell death. Both preincubation of MKN45 cells with interferon‐γ for 6 h and coculture with TNF‐α significantly increased the cytotoxicity of H. pylori. Both cytotoxic and non‐cytotoxic strains of H. pylori induced cell death. Expression of iNOS mRNA was observed in MKN45 cells at 6, 8 and 12 h after H. pylori inoculation. The cytotoxicity of H. pylori was inhibited by aminoguanidine and DNA fragmentation analysis showed that H. pylori induced apoptosis.

Conclusions
: These findings suggested that viable H. pylori induces apoptosis of gastric epithelial cells via nitric oxide. Our study indicated that iNOS expression plays an important role in gastric cell injury.
Endoscopic [13C]‐urea breath test for quantification of Helicobacter pylori infection
Authors: Suto Hiroyuki , Azuma Takeshi , Ito Shigeji , Ito Yoshiyuki , Miyaji Hideki , Yamazaki Yukinao , Kohli Yoshihiro , Kuriyama Masaru
Published: March 2003

Background
: We previously developed a new diagnostic method for Helicobacter pylori infection and called it the endoscopic [13C]‐urea breath test (EUBT). Here we evaluate the relationship between the EUBT results and the histological findings.

Methods
: The EUBT was performed on 137 patients with gastroduodenal diseases. After the collection of a baseline breath sample, gastroduodenal endoscopy was performed. Twenty milliliters of 0.05% phenol red solution containing 100 mg of [13C]‐urea was sprayed over the entire gastric mucosa under endoscopic observation. A breath sample was collected 15 min after spraying. The content of 13CO2 in the breath samples was measured by ratio mass spectrometry. Two biopsy specimens each from the antrum and the middle corpus were obtained for culture and histology. Helicobacter pylori colonization, activity, inflammation, atrophy and intestinal metaplasia were classified on a four‐point scale according to the Updated Sydney System.

Results
: We found positive correlations between the EUBT values and the H. pylori colonization and activity score in the antrum and corpus, and negative correlations between the EUBT values and the atrophy and intestinal metaplasia scores in the corpus.

Conclusions
: The EUBT can be an indicator of the intragastric bacterial load and the histological findings for H. pylori.
Role of steroid priming in the treatment of chronic hepatitis B
Authors: Yokosuka Osamu
Published: March 2003

Chronic hepatitis B is the result of the immunological response of the host to persistently replicating hepatitis B virus. Steroids can modulate this response; after steroid administration, viral replication increases and after drug withdrawal, it decreases in conjunction with a temporal increase in the transaminase level. Long‐term decrease of the viral level is observed in some patients, but the beneficial effect of steroid withdrawal alone has not been confirmed. Interferon and other anti‐viral agents can suppress virus replication, but the effect of these agents is still unsatisfactory. The combination of steroid priming and anti‐viral treatment may be beneficial. Recent large‐scale controlled trials indicate the utility of the combination therapy, but other randomized trials show no significant difference between therapy with or without steroid priming. Although steroid priming in combination with antiviral agents may be useful in some patients, it should be carefully performed due to the potential risk of liver failure.
Serum total bile acid level as a sensitive indicator of hepatic histological improvement in chronic hepatitis C patients responding to interferon treatment
Authors: Shima Toshihide , Tada Hisashi , Morimoto Michio , Nakagawa Yoshihiro , Obata Hirozumi , Sasaki Toshiyuki , Park Hyohun , Nakajo Shinobu , Nakashima Toshiaki , Okanoue Takeshi , Kashima Kei
Published: March 2003

Background and Methods
: Serum total bile acid (TBA) levels are used clinically as a sensitive and reliable index of hepatobiliary diseases. In the present study, to assess the clinical usefulness of determining TBA in interferon (IFN)‐treated patients, changes in liver function test values, including TBA and liver histology, were examined in 36 chronic hepatitis C patients for 3 years after a sustained response to IFN treatment.

Results
: Alanine aminotransferase and gamma‐glutamyl transpeptidase values significantly decreased during the period of IFN treatment compared to the same measures before IFN treatment. Albumin, cholinesterase, total cholesterol and platelet count values temporarily decreased during IFN treatment, then increased significantly and reached a plateau 6–12 months after the end of IFN treatment. The zinc sulphate turbidity test and TBA values began to decrease during IFN treatment and continued to decrease during the 3‐year follow‐up period. The histological activity index of the liver (Knodell’s score) significantly decreased, whereas the staging score was unchanged 1 year after the end of IFN treatment. In patients who had a TBA value > 10 μmol/L before IFN treatment, a significant correlation was observed between the decrease of TBA and liver histology grading score.

Conclusions
: A decrease in serum TBA level reflected histological improvement in the liver more precisely than did changes in the other liver function test values following IFN therapy.

© 2000 Blackwell Science Asia Pty Ltd
Metronidazole‐resistant Helicobacter pylori in an urban Asian population
Authors: Teo Eng‐Kiong , Fock Kwong‐Ming , Ng Tay Meng , Khor Christopher Jen Lock , Tan Ai Ling
Published: March 2003

Background
: Helicobacter pylori eradication is the mainstay in the treatment of H. pylori‐associated peptic ulcer disease. Metronidazole is an important component in most eradication regimens. However, the presence of metronidazole‐resistant H. pylori adversely affects the efficacy of such regimens. We aimed to study the prevalence of metronidazole resistance in our population, and the factors associated with its presence.

Methods and Results
: From September 1993 to September 1996, 459 H. pylori isolates were collected and analysed. The overall resistance rate was 62.7%. The rate was significantly higher among women compared with men (P < 0.05). When the results were analysed according to each year, there was a significant increase in the resistance rate from 50.5% in the first year to 72.7% in the third year (P = 0.0039).

Conclusions
: There was a significant rise in the prevalence of metronidazole resistance over a 3‐year period. The presence of metronidazole resistance adversely affects the eradication rates of nitroimidazole‐based regimens. Hence, in a population with a high prevalence of metronidazole resistance, the use of non‐nitroimidazole‐based therapy may be more efficacious. This information on resistance rates is important for the empirical choice of antibiotic against H. pylori in a population.
Identification of a pre‐S2 mutant in hepatocytes expressing a novel marginal pattern of surface antigen in advanced diseases of chronic hepatitis B virus infection
Authors: Fan Yu‐Fen , Lu Chen‐Chan , Chang Yu‐Chuang , Chang Ting‐Tsung , Lin Pin‐Wen , Lei Huan‐Yao , Su Ih‐Jen
Published: March 2003

Background and Aims
: The expression of hepatitis B viral (HBV) antigens in liver tissue reflects the replicative status of chronic HBV infection. We have previously recognized a novel marginal pattern of hepatitis B surface antigen (HBsAg) in hepatocytes, which usually clusters in groups and emerges at the late non‐replicative phase. This study was designed to investigate whether the marginal‐type HBsAg represented the gene product of a specific HBV‐surface mutant.

Methods
: Microdissection of cirrhotic nodules homogeneously expressing marginal HBsAg was performed on two of 12 resected livers from HBsAg‐seropositive patients with hepatocellular carcinoma. The gene presumably encoding marginal HBsAg was polymerase chain reaction (PCR)‐cloned, sequenced and analysed. In vitro transfection and expression of the cloned surface mutant plasmids were performed on the Huh7 cell line to illustrate intrahepatic HBsAg expression.

Results
: Immunohistochemical staining revealed that the marginal HBsAg was positive for pre‐S1 and thus contained large surface proteins. The PCR cloning and sequencing of the genes presumably encoding marginal‐type HBsAg in both cases revealed the same deletion at the 5′ terminus (nt 2–55) of pre‐S2. A point mutation on the small‐surface (S) antigen was also found in one case. The pre‐S2 deletion sequence and the mutation sites of the S gene coincide with human lymphocyte antigen‐restricted T‐ and/or B‐cell epitopes. In vitro transfection of the mutant plasmid revealed a blot‐like retention or accumulation of HBsAg in the cytoplasm or at the periphery of hepatocytes, accompanied by a decreased secretion of HBsAg in the culture supernatant, mimicking intrahepatic expression.

Conclusion
: A natural pre‐S2 deletion mutant was identified in hepatocytes expressing a novel marginal pattern of HBsAg, which probably contains mutant, large, surface proteins. The biological significance of the pre‐S2 deletion mutant should be interesting in view of the clustering proliferation of hepatocytes expressing marginal HBsAg.
School absenteeism after upper gastrointestinal endoscopy in children
Authors: Treepongkaruna S , Lee K , Giltinan D , Catto‐Smith Anthony G
Published: March 2003

Background and Aims
: To examine the functional impact of upper gastrointestinal endoscopy as a day procedure, particularly in relation to subsequent school attendance.

Methods
: Symptoms and morbidities were prospectively recorded from school‐aged children during observation in hospital and for 3 days at home after endoscopy by using a structured questionnaire. Reasons for school absence were identified.

Results
: Sixty children (31 boys, 29 girls) were enrolled in the study (mean age 10.6 ± 2.8 years, range 6.1–16.2 years). Following the procedure, symptoms were reported at home in 68.3% (same day), 56.7% (day 1) and 20% (day 2). The commonest symptoms were sore throat, tiredness and dizziness. Twenty‐nine children (48.3%) did not attend school on the day following the procedure but most (26 of 29) had returned to school by the second day. The main reason for their absence was residual physical discomfort related to the procedure (55.2%).

Conclusions
: Persisting physical discomfort and school absenteeism are common following upper gastrointestinal endoscopy in children.
Bilirubin and bile acids may modulate their own metabolism via regulating uridine diphosphate‐glucuronosyltransferase expression in the rat
Authors: Li Yan Q , Prentice David A , Howard Monique L , Mashford Maurice L , Desmond Paul V
Published: March 2003

Background and Aims
: Uridine diphosphate (UDP)‐glucuronosyltransferase (UGT) is a critical enzyme in the elimination of bilirubin and it also plays a role in the metabolism of bile acids. The aim of this study was to determine whether bilirubin and bile acids could modulate their own metabolism by regulating UGT levels in cultured rat hepatocytes.

Methods and Results
: Incubation of hepatocytes with bilirubin (48 μmol/L) for 24 h significantly increased the mRNA expression of UGT1A1 and UGT1A5, two UGT isoforms responsible for the conjugation of bilirubin. The induction of UGT1A1 and UGT1A5 by bilirubin was concentration and time dependent. Treatment with chenodeoxycholic acid, cholic acid, deoxycholic acid, hyodeoxycholic acid and lithocholic acid at a concentration of 100 μmol/L for 48 h significantly enhanced the mRNA expression of UGT2B1, a UGT isoform responsible for the glucuronidation of bile acids. The UGT2B3 mRNA level was also increased by hyodeoxycholic acid. The regulation of UGT2B1 mRNA by chenodeoxycholic acid and hyodeoxycholic acid was dose and time dependent.

Conclusion
: Our results suggest that bilirubin and bile acids can induce UGT expression and as a result, these compounds may modulate their own metabolism. Such regulation could play a compensatory role in the pathological increased concentrations of these compounds in some hepatobiliary diseases.
Effects of simvastatin on hepatic cholesterol metabolism, bile lithogenicity and bile acid hydrophobicity in patients with gallstones
Authors: Smith Jeffery L , Roach Paul D , Wittenberg Leonie N , Riottot Michel , Pillay S. Praga , Nestel Paul J , Nathanson Les K
Published: March 2003

Background and Aims
: There is limited information available on the effects of 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors on hepatic and biliary cholesterol metabolism in patients with gallstones. The aims of this study were to determine the effect of simvastatin on the regulatory elements of cholesterol metabolism that determine the concentrations of cholesterol in plasma and bile.

Methods
: Thirty‐one gallstone patients were enrolled in the study; 17 were treated with 20 mg simvastatin daily for 3 weeks prior to cholecystectomy and 14 served as controls. Samples of blood, liver, gall‐bladder bile and bile from the common bile duct (CBD) were collected and analysed.

Results
: The plasma cholesterol (−30%), triacylglycerol (−23%) and low‐density lipoprotein (LDL) cholesterol (−42%) concentrations were significantly lowered by simvastatin treatment, as was the plasma lathosterol : cholesterol (−70%), which reflects whole‐body cholesterol synthesis. Despite these changes, the hepatic LDL receptor protein and LDL receptor activity in circulating mononuclear cells were similar in both groups. There were no differences in the plasma phytosterol : cholesterol, which reflects the intestinal cholesterol absorption capacity or in the activity of hepatic acyl‐coenzyme A : cholesterol acyltransferase. There were however, lower cholesterol concentrations in CBD (−68%) and gall bladder (−41%) bile, and decreased lithogenic (−47%) and bile acid hydrophobicity (−22%) indices of CBD bile in the simvastatin group.

Conclusions
: These data indicate that simvastatin reduced plasma and biliary cholesterol levels primarily by reducing cholesterol synthesis. The reduction in CBD bile lithogenicity and bile acid hydrophobicity by simvastatin suggests that this agent may be useful for people who have early stages of cholesterol gallstone development and in whom a choleretic effect is required.
Incidence and prevalence of ulcerative colitis in the Songpa‐Kangdong District, Seoul, Korea, 1986–1997
Authors: Yang Suk‐Kyun , Hong Weon‐Seon , Min Young I , Kim Hak Y , Yoo Jae Y , Rhee Poong‐Lyul , Rhee Jong C , Chang Dong K , Song In S , Jung Sung A , Park Eung‐Bum , Yoo Hyo M , Lee Dong K , Kim Young K
Published: March 2003

Background and Aims
: Ulcerative colitis (UC) is regarded as a rare disease in developing countries, but accurate data are generally lacking. We performed the present study to evaluate the incidence and prevalence of UC in Korea.

Methods
: A retrospective study was performed from 1986 to 1997 in the Songpa‐Kangdong district of Seoul, Korea. To recruit UC patients as completely as possible, multiple information sources including all medical facilities in the study area and three referral centres located nearby, but outside the study area were used. The incidence and prevalence rates were adjusted using the 1997 Korean population statistics.

Results
: During the study period, a total of 94 incident cases were identified, for an adjusted mean annual incidence rate of 0.68 per 100 000 inhabitants. On 31 December 1997, 91 patients with UC lived in the study area, giving an adjusted prevalence rate of 7.57 per 100 000 inhabitants. By using the Poisson regression analysis, the annual incidence rate increased significantly from 0.20 per 100 000 inhabitants in 1986–1988 to 1.23 per 100 000 inhabitants in 1995–1997 (P < 0.005). Patient age at diagnosis, the interval from onset of symptoms to diagnosis, and the disease extent at diagnosis were fairly constant throughout the study period.

Conclusions
: The incidence and prevalence of UC in our study area are still low compared with those of Western countries, but the incidence rate is steadily increasing.
Yield from colonoscopic screening in people with a strong family history of common colorectal cancer
Authors: Dowling Damian J , John D James B St , Macrae Finlay A , Hopper John L
Published: March 2003

Background and Aims
: People with a strong family history of common (so‐called ‘sporadic’) colorectal cancer are generally advised to undergo colonoscopic screening, but the starting age for this is unclear. An audit was performed to study the age‐related yield of screening colonoscopy in this risk group.

Methods
: A prospective audit of the outcome of screening colonoscopy was performed on a cohort of 232 people with a strong family history of common colorectal cancer. All were registrants in a familial bowel cancer service solely because of their family medical history. They had no bowel symptoms and no prior endoscopic investigation of the large bowel.

Results
: Neoplastic lesions were detected by using colonoscopy in 33 participants. In 27 participants, the major lesion was a small tubular adenoma, four had an advanced adenoma and two had cancer. More neoplastic (P = 0.02) and advanced neoplastic (P = 0.03) lesions were found in those patients aged ≥ 50 years. Only one advanced adenoma was detected in a participant below the age of 50 years.

Conclusion
: The yield from screening colonoscopy in young people (< 50 years) with a strong family history of common colorectal cancer is low, placing doubt on the need for colonoscopic screening before the age of 50 years.
Hepatocellular carcinoma
Authors: Tang Zhao‐You
Published: March 2003

Abstract Hepatocellular carcinoma (HCC) has ranked second in cancer mortality in China since the 1990s and is increasing in frequency among males in many countries. Hepatitis B and C viruses, aflatoxin and algal toxin in the contaminated drinking water remain major aetiological factors and hepatitis G virus and transfusion‐transmitted virus can not be excluded. A prospective randomized control trial screening for HCC in a high‐risk population using alpha fetoprotein (AFP) and ultrasonography has demonstrated a decrease in HCC mortality. Rapidly progressing medical imaging has continuously contributed to the improving treatment results. Surgical resection still plays a major role in influencing prognosis of HCC. Studies on recurrence and metastasis after curative resection have become a key issue for further improvement of the surgical outcome. Regional cancer therapies are progressing rapidly, based on the advances in early diagnosis. The advantages and disadvantages of these are noted. Multimodality combination and sequential treatment has been accepted as an important approach for unresectable HCC and cytoreduction and sequential resection have attracted attention. Conformal radiotherapy has shown important potential for HCC treatment. Intra‐arterial chemotherapy has been repeatedly proved effective; however, systemic chemotherapy for HCC remains disappointing. The effects of tamoxifen are questionable, whereas α‐interferon has been shown to have significant potential, particularly in prevention of recurrence. All of these treatments have resulted in continuing improvement of HCC prognosis in some centres.
Intestinal failure
Authors: Irving Miles
Published: March 2003

Abstract The recognition of intestinal failure (IF) as a distinct clinical entity over the past 20 years has primarily come about through the emergence of increasingly successful treatment based on use of intravenous nutrition delivered both in hospital and at home. Intestinal failure has many and varied causes, and may be complete or partial, acute and short lived, or chronic and permanent. If the latter, lifetime dependence on parenteral nutrition will usually be indicated and where possible patients are trained in the techniques of home parenteral nutrition (HPN). The success of HPN is itself primarily dependent on meticulous catheter care protocols. Sufficient numbers of such patients have now been entered into randomized controlled trials for there to be an evidence base for this aspect of IF treatment. The balanced delivery of nutrients, especially when an enteral component is included, can prevent many of the complications, such as liver and bone disease, recorded as being associated with prolonged total parenteral nutrition. However, nutritional balance is difficult to achieve in the presence of total gut resection, multiple intestinal fistulas or persisting sepsis. Surgical approaches involving bowel lengthening and reversed loops are indicated in selected patients. They have limited success and carry with them the risk of further loss of precious residual bowel. Greatest promise is held out by intestinal transplantation, but the problems associated with the powerful immunosuppression required reduce the value of this treatment. Specialized referral units for patients with severe and persistent IF can produce a high percentage of clinically effective and cost‐effective outcomes.
Human biliary β‐glucuronidase activity before and after relief of bile duct obstruction: Is it the major role in the formation of pigment gallstones?
Authors: Chen Chiung‐Yu , Shiesh Shu‐Chu , Tsao Hui‐Chen , Lin Xi‐Zhang
Published: March 2003

Background and Aims
: The bacterial β‐glucuronidase (bBG) can deconjugate conjugated bilirubin to form calcium bilirubinate gallstone. Yet, the role of the human biliary β‐glucuronidase (hBG) in the pathogenesis of pigment gallstone formation still remains unsolved.

Methods
: Hepatic bile was collected from bile‐duct‐obstructed patients on the day of, and 3 days after, biliary drainage. Patients were divided into pigment‐stone (PS) group (n = 34) and stone‐free (SF) group (n = 29). All patients of the PS group had the complication of cholangitis. The concentrations of bile contents and the activities of bBG and hBG were measured.

Results
: The activities of hBG and bBG in bile obtained on the day of biliary drainage were higher in the PS group than in the SF group (activities corrected for bile salt concentration: hBG 128.7 ± 340.0 vs 13.1 ± 25.0 U/mmol; bBG 12.5 ± 22.2 vs 4.6 ± 7.7 U/mmol, P < 0.05). This difference disappeared after biliary drainage. The changes of enzyme activity in the bile of the SF group were unremarkable before and after biliary drainage. The mean concentrations of bile pigments and free calcium in the PS group were lower than those in the SF group.

Conclusions
: An increase in the activity of hBG may be a secondary response, developed after bile duct inflammation because it was elevated only when the bile duct obstruction was associated with infection.
Changes in prostaglandin and nitric oxide levels in the hyperdynamic circulation following liver resection
Authors: Lai Oi Fah , Chow Pierce Kh , Tan Sally , Song In Chin , Soo Khee Chee , Aw Swee Eng , Yu Wing Kwong , Fook‐Chong Stephanie Mc , Satchithanantham Somanesan , Chan Steven Tf
Published: March 2003

Background and Aims
: Significant changes in hepatic haemodynamics occur after major hepatectomy, but the pathogenesis of this phenomenon is unclear. This study investigates the serum profile of prostaglandin and nitric oxide in the hepatic and systemic circulation before and after hepatectomy and the temporal relationship of these to changes in the hepatic blood flow.

Methods
: Blood samples were collected from the internal jugular, portal and hepatic veins of six Yorkshire pigs (17–25 kg) before, immediately after and 48 h after partial hepatectomy.

Results
: Serum levels of prostacyclin I2 (PGI2) and prostaglandin E2 (PGE2) from the systemic circulation, the portal circulation and from the hepatic veins were found to differ considerably even before hepatectomy. After the hepatectomy was performed, there was a significant rise in PGI2 levels in the systemic circulation (P = 0.027). Hepatic blood flow and cardiac output were measured before hepatectomy, 24 and 48 h after hepatectomy in another six pigs. A significant increase in hepatic blood flow (P = 0.029) occurred after the hepatectomy and this was accompanied by a concomitant increase in the cardiac output (P = 0.042). The increase in PGI2 concentration in the systemic circulation after hepatectomy appears to accompany the development of hyperdynamic hepatic and systemic circulations. No significant change was found in circulating PGE2 levels in the systemic, portal and hepatic veins at the three collection intervals (i.e. pre, post and 48 h after hepatectomy). The PGE2 levels in the hepatic vein, however, were significantly higher from than in the portal vein (P = 0.028). No significant changes were observed in the level of nitric oxide.

Conclusion
: This study demonstrates an increase in the total hepatic blood flow after hepatectomy together with a threefold increase in prostacyclin in the systemic circulation. The liver was identified as the main source of circulatory prostaglandin.
Activation of mucosal phospholipase D in a rat model of colitis
Authors: Sakamoto Teruhiko , Okamura Shin‐Ichi , Saruya Shin‐Ya , Yamashita Satoshi , Mori Masatomo
Published: March 2003

Abstract Background and Aims: Phospholipase D (PLD) hydrolyzes phosphatidylcholine and produces lipid second messengers. Although cellular PLD has recently been recognized as an important signal‐transmitting enzyme, the role of PLD in pathophysiologic conditions is largely unknown. In particular, the regulation of PLD in intestinal inflammation has not been previously investigated. The aim of the present study was to elucidate the role of PLD in experimental colitis.

Methods: Rats were intracolonically administered acetic acid and assessed for mucosal damage, mucosal PLD activity, mucosal myeloperoxidase activity, mucosal chemiluminescence and luminal concentration of leukotriene B4. Acetic acid treatment induced acute mucosal injury that was maximal at 24 h after treatment.

Results: Mucosal PLD activity was significantly elevated and correlated with mucosal damage. Chemiluminescence in colitic mucosa was inhibited by the addition of ethanol which suppresses the formation of phosphatidic acid catalyzed by PLD.

Conclusion: These results suggest that PLD is activated in experimental colitis in rats and that PLD may play a role in mucosal damage induced by reactive oxygen metabolites.
Endogenous endothelin in a rat model of acute colonic mucosal injury
Authors: Sugimachi Masamitsu , Kiyohara Tatsuya , Murayama Yoko , Minami Takeshi , Miyazaki Yoshiji , Miyagawa Jun‐Ichiro , Shinomura Yasuhisa , Matsuzawa Yuji
Published: March 2003

Abstract Background: Endothelin (ET) is involved in various biologic activities in non‐vascular and vascular tissues. While ET has some significant effects on gastrointestinal functions, the possible role of endogenous ET in the host response to mucosal injury has not been well clarified.

Methods: The present study describes an investigation of the effects of an endothelin A receptor antagonist, BQ‐123, on lactate dehydrogenase (LDH), mucus and albumin flux into the perfusate in a rat model of acute colonic injury, induced by acetic acid perfusion. The present study also examined localization of ET in damaged rat colons by using immunohistochemistry.

Results: A 4% acetic acid treatment induced mild mucosal damage of perfused rat colon and increased LDH as well as albumin and protein‐bound hexose release into the perfusate. Pretreatment with BQ‐123 significantly reduced LDH activity and protein‐bound hexose concentration in the perfusate and delayed the reduction of albumin leakage from damaged mucosa. Vascular endothelial, neural and surface epithelial cells of the colon showed strong ET‐like immunoreactivity. Mucosal damage markedly influenced ET expression by epithelial cells. Mild mucosal damage decreased the ET expression by surface epithelial cells while moderate mucosal damage induced a mosaic location of ET‐positive epithelial cells in the crypt. Severe mucosal damage abolished the ET expression by epithelial cells.

Conclusions: Endothelin may play a role in the host response to acute mucosal damage. Mucosal ET production is significantly affected by mucosal injury.
Predictors of health‐care consultation for recurrent abdominal pain among urban schoolchildren in Malaysia
Authors: Boey Christopher Chiong Meng , Goh Khean‐Lee
Published: March 2003

Aim: To look at the predictors of health‐care consultation for recurrent abdominal pain among urban schoolchildren in Malaysia.

Methods: Recurrent abdominal pain was defined as ‘at least three episodes of abdominal pain, severe enough to affect a child's activities over a period longer than 3 months. A health‐care consulter was defined as a child who had been brought to see a doctor regarding recurrent abdominal pain at least once in the past year. Children aged between 9 and 15 years were randomly chosen from schools in the city of Petaling Jaya, given questionnaires to fill in and interviewed to determine whether they fulfilled the above criteria for having symptoms of recurrent abdominal pain and for being a consulter. Bivariate analysis and multiple logistic regression analysis were performed on the data obtained.

Results: One hundred and forty‐three (9.61%) children fulfilled the criteria for recurrent abdominal pain out of a total of 1488 schoolchildren interviewed. There were 65 (45.5%) consulters and 78 (54.5%) non‐consulters. Among the consulters, the male to female ratio was 1:1.4, while among the non‐consulters, the ratio was 1:1.1. On bivariate analysis, the Chinese had a significantly lower likelihood to consult a doctor (P = 0.02), while the other two races did not show any increase in consultation (Malays, P = 0.08; Indians, P = 0.21). Among those with severe pain, there was a significantly higher prevalence of consulters (P < 0.01). Furthermore, those whose sleep was interrupted by abdominal pain were more likely to consult (P < 0.01). Children who had consulted a doctor were more likely to be missing school because of abdominal pain (P < 0.01). Following multiple logistic regression analysis, ethnicity was no longer a significant predictor.

Conclusions: Approximately 45.5% of schoolchildren with recurrent abdominal pain in an urban setting were brought to see a doctor. Predictors of recent health‐care consultation were school absence, pain severity and interruption of sleep caused by abdominal pain.