Volume 67 - 2004 - Fasc.4 - Original articles
Non-endoscopic diagnosis of multifocal atrophic gastritis ; efficacy of serum gastrin-17, pepsinogens and Helicobacter pylori antibodies
Background/Aims : Infection with H.pylori is an important risk factor for the development of gastric cancer and glandular atrophy is an intermediate stage in gastric carcinogenesis. While screening the patients with atrophic gastritis by endoscopy is unrealistic, a concept of "serological gastric biopsy" based on measurement of gastric secretory proteins and peptides should be further validated. We sought to determine if the laboratory panel composed of serum PGI and protein stimulated gastrin-17 might select patients with MAG, and what is diagnostic significance of H.pylori serology in population of high prevalence of H.pylori infection.
Material and methods : 55 consecutive patients of both sexes (M/F 25/30 ; range of age 55 -81 years) were referred for gastro- scopy with antrum and corpus mucosal biopsies. Patients with histological signs of glandular atrophy at any site of the stomach were considered to have multifocal atrophic gastritis. A first blood sample was collected for measurement of basal gastrin-17, pepsinogens and H.pylori IgG-antibodies, and second was taken 20 minutes after use of protein-rich drink to measure stimulated gastrin-17.
Results : Signs of mucosal atrophy were found in 19 patients, while 29 patients showed non-atrophic gastritis and seven H.pylori-negative patients had no histological pathology. Low serum level of stimulated gastrin-17 (< 5 pmol/l) and/or pepsino- gen I (< 50 µg/l), were found in 16 of 19 patients (84,2%) with and in 7 of 36 patients (19,4%) without atrophy in the histological study. Combining of H.pylori serology with serum levels of secre- tory peptides had no significant effect on diagnostic sensitivity of the test panel.
Conclusion : The test panel composed of pepsinogen I and pro- tein stimulated gastrin-17 may be used as the "serological gastric biopsy" detecting multifocal atrophic gastritis. The diagnostic sen- sitivity of this test panel is not increased by knowledge of H.pylori status. (Acta gastroenterol. belg., 2004, 67, 320-326).
Role of chronic atrophic gastritis of the body-fundus and achlorydria in the development of epithelial dysplasia and gastric carcinoma
Background/ Aim : Chronic atrophic gastritis of the body-fun- dus with hypo-achlorydria has been long since considered the pre- cursor of gastric cancer (GC). A study has been made about the histological pattern of the body-fundic mucosa (oxyntic area) in course of preneoplastic lesions (epithelial dysplasia), associated or progressed to gastric cancer, in order to evaluate the real association with chronic atrophic gastritis and, therefore, with a reduced acid secretion.
Methodology : The study of the histological condition of the body-fundic mucosa and of the acid secretion has been effected in 120 cases of epithelial dysplasia (ED) from January 1990 to November 1997.
Fifteen years single center experience in the management of progressive familial intrahepatic cholestasis of infancy
Recent advances in genetics and in physiopathology of bile com- position and excretion have clarified the understanding of pro- gressive familial intrahepatic cholestasis (PFIC).
The aim of the present study is to review the experience of our center in terms of diagnosis, management and outcome of 49 pedi- atric PFIC patients, belonging to the three classical subtypes described.
We analyse the clinical, biological, and histological patterns and review the response to the medical and surgical treatment and the global outcome.
The only clinical difference between the different subtypes of PFIC patients was the intensity of pruritus. Serum gamma-glu- tamyltransferase (GGT) and liver histology allowed to differenti- ate PFIC III from PFIC I and II patients.
High levels of biliary bile acids in 2 low-GGT patients was asso- ciated with favourable outcome. Response to ursodesoxycholic acid (UDCA) varies from patient to patient and was not associat- ed to a particular subtype of PFIC. In five patients of this cohort, external biliary diversion was performed without improvement.
Transplantation is indicated whenever medical treatment fails to restore normal social life, growth and well being of the child and it is associated with excellent survival (> 90%). (Acta gastroenterol. belg., 2004, 67, 313-319).
