Alimentary Pharmacology and Therapeutics Symposium Series

Summary Background Ghrelin is a novel appetite‐promoting peptide secreted primarily from the A‐like cells in the gastric fundic mucosa. As gastric inflammation caused by Helicobacter pylori infection extends, the number of ghrelin‐producing A‐like cells is diminished and gastric ghrelin content decreases significantly. We previously reported that plasma levels of ghrelin, which correlated well with the serum levels of pepsinogen (PG) I and PG I/II ratio, decreased as gastric mucosal atrophy increased in non‐ulcerogenic conditions and that plasma ghrelin level increased in rats with cysteamine‐induced duodenal ulcer. Aim To investigate the plasma levels of ghrelin in patients with peptic ulcer disease. Patients and Methods Two hundred and eighty‐six patients with epigastric symptoms, who underwent upper gastrointestinal endoscopy, were enrolled. Blood samples were collected after a 12‐h fast before endoscopy. Patients were divided into four groups, namely chronic gastritis with high PG ( n = 197), chronic gastritis with low PG ( n = 58), duodenal ulcer ( n = 14) and gastric ulcer ( n = 17) and plasma concentrations of total and active ghrelin as well as serum concentrations of PG I and PG II were measured by radioimmunoassay. Six patients with duodenal ulcer and seven with gastric ulcer were also examined after ulcer healing. Results Plasma ghrelin levels were significantly higher in patients with duodenal ulcer or gastric ulcer than in those without ulcers. Elevated plasma total ghrelin levels did not significantly change after the healing of ulcers. Conclusions Plasma ghrelin levels were significantly higher in patients with peptic ulcer than in those with gastritis without ulcer. This finding suggests a possible relationship between mucosal injury susceptibility and elevated fasting plasma ghrelin.

H. SUZUKI

T. MASAOKA

Y. NOMOTO

H. HOSODA

M. MORI

T. NISHIZAWA

Y. MINEGISHI

K. KANGAWA

T. HIBI

Alimentary Pharmacology & Therapeutics Symposium Series

Increased levels of plasma ghrelin in peptic ulcer disease

消化性溃疡病患者血浆胃饥饿素水平升高

Summary Background CagA+Helicobacter pylori strains are associated with the development of gastroduodenal diseases. H. pylori possess a type IV secretion system that is responsible for the translocation of CagA into host cells. Aim To investigate the correlation between the CagA status and the severity of histological gastritis and to analyse the tyrosine phosphorylation of CagA. Methods A total of 149 H. pylori status was determined via urine antibody to H. pylori, histological examination and serum antibody against CagA. Histological gastritis was evaluated using the updated Sydney system and scored from 0 to 3. Tyrosine phosphorylation was analysed using immunoprecipitation and immunoblotting. Results Anti-CagA titres were correlated with the severity of mononuclear cell infiltration. In contrast, mean anti-CagA in patients with grade 2 bacterial density was significantly higher than those with grade 0 (P < 0.01). Mean anti-titre in patients with grade 3 tended to be lower than that seen with grade 2. CagA tyrosine phosphorylation was significantly more common in bacteria isolated from CagA-antibody-negative patients (93%;13/14) than from CagA-antibody-positive patients (29%; 4/14, P = 0.0007). Conclusions Host–bacteria interaction is regarded as one of the important factors in the development of gastroduodenal diseases.

R. DEGUCHI

K. WATANABE

Y. KOGA

H. KIJIMA

A. TAKAGI

Interaction between Helicobacter pylori and immune response to CagA: CagA antibody may down‐regulate bacterial colonization and tyrosine phosphorylation

幽门螺杆菌与CagA免疫反应的相互作用：CagA抗体可能下调细菌定植和酪氨酸磷酸化

Summary Background Gastro‐oesophageal flap valve (GEFV) grade correlated with endoscopic reflux oesophagitis (RE) prevalence. Aim To investigate relationships among gastro‐oesophageal reflux disease (GERD) symptoms, RE and/or non‐erosive reflux disease (NERD) and GEFV grades in subjects undergoing endoscopy. Methods We enrolled 1305 subjects from whom endoscopic results and the results of a self‐administered questionnaire (QUEST) were available. Subjects were evaluated for GERD symptoms (QUEST score), GEFV grade, RE and gastric mucosal atrophy. Results Total GERD prevalence, including symptomatic GERD (QUEST score ≥ 4) and/or RE, was 27%. RE grade and prevalence increased with GEFV grade. QUEST scores and GEFV grades showed a positive correlation. NERD prevalence was 14% and increased with GEFV grade, but the relationship was weaker than that between RE and GEFV. Comparing RE‐negative subjects by GEFV grade, GERD symptoms were noted in 10%, 19%, 36% and 52% with GEFV grades I, II, III and IV, respectively. Neither type of gastric mucosal atrophy correlated with GEFV grade. Conclusions Total GERD, NERD and RE prevalences increased with GEFV grade. Subjects with high GEFV grades often complain of GERD symptoms, even without RE. Our findings suggest that endoscopic GEFV evaluation provides a useful clinical index for diagnosing GERD.

M. IWAMOTO

K. KATO

S. MIZUNO

S. MIYAMOTO

R. TAKEUCHI

A. IWASAKI

Y. ARAKAWA

Evaluation of gastro-oesophageal flap valve is useful for diagnosing gastro-oesophageal reflux disease

评估胃食管瓣膜对诊断胃食管反流病具有重要意义

Summary Background The [ 13 C]‐ethanol breath test (EBT) has been proposed as a novel non‐invasive laboratory test to detect the degradation of ethanol into CO 2 . However, this method has not yet been evaluated clinically. Aim To investigate the factors that influence [ 13 C]‐EBT. Methods Twenty‐six healthy volunteers were instructed to drink 100 mL of beer (4 g ethanol) containing 100 μ L of [ 13 C]‐ethanol. Breath samples were collected every 15 min before and after the intake of ethanol solution and 13 CO 2 ‐enrichment was measured using mass spectrometry. CO 2 excretion was then calculated, and the results were evaluated using kinetic parameters ( T max , C max , AUC). Results T max (min) was significantly shorter in men than in women but not C max and AUC. Infection with H. pylori had no impact on all kinetic parameters. Genetic alcohol dehydrogenase (ADH) polymorphisms did not affect 13 CO 2 excretion, but C max (11.1 ± 3.4% dose/h, n = 16) and AUC (10.5 ± 3.4% dose) were slightly increased in aldehyde dehydrogenase (ALDH)‐deficient individuals (heterozygote of ALDH2*2) (13.2 ± 3.2 and 12.9 ± 4.5, respectively; n = 10). Conclusions [ 13 C]‐EBT is capable of assessing the metabolic processing of 100 mL beer in a non‐invasive way. Kinetic parameters are partially influenced by ALDH polymorphism but not by gender, H. pylori infection or ADH polymorphism.

M. Suzuki

S. Tanaka

H. Komatsu

T. Nakane

N. Sasaki

K. Maruyama

H. Suzuki

H. Ishii

Makoto Suematsu

T. Hibi

Evaluation of alcohol metabolism in humans using the non‐invasive [13C]‐ethanol breath test – influence of gender, Helicobacter pylori infection and polymorphism of alcohol‐oxidizing enzymes

利用非侵入性[13C]‐乙醇呼气测试评估人类酒精代谢——性别、幽门螺杆菌感染及酒精氧化酶多态性的影响

Alimentary Pharmacology & Therapeutics Symposium SeriesVolume 2, Issue 2 p. 311-313 Introduction: pharmacodynamic and pharmacokinetic properties of proton pump inhibitors and their clinical impact – focus on rabeprazole P. BYTZER, P. BYTZER Department of Medical Gastroenterology, Glostrup University Hospital, Glostrup, Copenhagen, DenmarkSearch for more papers by this author P. BYTZER, P. BYTZER Department of Medical Gastroenterology, Glostrup University Hospital, Glostrup, Copenhagen, DenmarkSearch for more papers by this author First published: 26 June 2006 https://doi.org/10.1111/j.1746-6342.2006.00064.x Dr P. Bytzer, Department of Medical Gastroenterology, Glostrup University Hospital, DK-2600 Glostrup, Copenhagen, Denmark.E-mail: peter.bytzer@dadlnet.dk Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume2, Issue2July 2006Pages 311-313 RelatedInformation

P. BYTZER

Introduction: pharmacodynamic and pharmacokinetic properties of proton pump inhibitors and their clinical impact – focus on rabeprazole

引言：质子泵抑制剂的药效学和药代动力学特性及其临床影响——聚焦雷贝拉唑

Summary A workshop on acid‐related disorders in paediatric and elderly populations was held in Asia in 2006 to raise awareness that: (i) these particular age groups require special consideration in their disease management; (ii) to clarify what issues need to be addressed in these populations and (iii) to reach a consensus on recommendations for the management of gastro‐oesophageal reflux disease and other acid‐related disorders in children and the elderly. Of note, acid‐related disorders, particularly gastro‐oesophageal reflux disease in these populations are less well recognized and studied than those in the adult population between the ages of 20 and 60 years. A distinguished faculty of practicing gastroenterologists and key opinion leaders from several Asian countries and the United States were thus enlisted to address these issues in the workshop.

F. K. L. CHAN

B. D. GOLD

Y. KINOSHITA

A. O.‐O. CHAN

M.‐S. R. WONG

H. D. MAKMUN

B. OVARLARNPORN

B. VIVATVAKIN

J.‐T. LIN

B.‐S. SHEU

W.‐H. CHANG

Introduction: current practice in acid‐related disorders in Asian countries, and workshop background, design and goals

引言：亚洲国家酸相关疾病的现状，以及研讨会的背景、设计和目标

Summary The workshops developed eight concensus statements for the diagnosis and management of paediatric acid‐related disorders or GERD, and five statements for geriatric acid‐related disorders or GERD, suitable for clinical use in Asia.

Clinical practice recommendations for acid‐related disorders or GERD from childhood to old age in Asia: summary of workshop report

亚洲从儿童到老年酸相关疾病或胃食管反流病的临床实践建议：研讨会报告摘要

Summary The population of Japan is rapidly ageing and this, along with the Westernization of the diet, is expected to increase the prevalence of gastro‐oesophageal reflux disease. Issues that call for attention by Asian gastroenterologists in the management of gastro‐oesophageal reflux disease in the geriatric population include functional changes associated with ageing, such as a lower sensitivity to acid stimulation or pain leading to more atypical presenting symptoms vs. greater severity of disease, common swallowing problems, polypharmacy, and the slower metabolism of the drugs by the kidney. The optimal management of acid‐related disorders in the elderly will need to adequately address all these issues.

Review article: management issues in acid‐related disorders in the elderly

综述文章：老年人酸相关疾病的处理问题

Summary It is critical for the clinician who cares for children to distinguish between normal physiological gastro‐oesophageal reflux (GER), and signs and symptoms that occur due to the persistent reflux, defined as gastro‐oesophageal reflux disease (GERD). The underlying natural history of physiological GER in the paediatric population up to about 12 years of age, is quite distinct from normal reflux in adults. Conversely, the underlying pathophysiology of GERD in both age groups is for the most part similar. Regurgitation symptoms, which peak by 4‐6 months of age, appear to resolve commonly by 12‐18 months of life. However, there is a growing body of evidence that demonstrates that GERD may not be outgrown in a subset of children. In practice, many clinicians include an empiric therapeutic trial of an H 2 receptor antagonist (H 2 RA) or proton pump inhibitor accompanied by symptom resolution for the diagnosis of GERD. GERD‐associated symptoms in the paediatric population range from regurgitation, often accompanied by arching and irritability, to feeding refusal, and/or poor growth to respiratory symptoms such as nocturnal and/or chronic cough. Upper endoscopy with biopsy may be useful in documenting the presence and severity of macroscopic and microscopic mucosal abnormalities, as well as excluding other disorders such as eosinophilic oesophagitis. Conservative management, particularly useful in mild GERD, consists of positioning during and after feeds, a 2‐ to 4‐week trial of hydrolysate formula, addition of cereal to formula, and smaller, more frequent feeds. Among the current pharmacotherapeutic options available in the United States (US), the prokinetic agent metaclopramide and the acid‐inhibitory agents (H 2 RAs, proton pump inhibitors) are the most widely prescribed. Numerous clinical investigations in both adults and children demonstrated that the proton pump inhibitors are more effective than the H 2 RAs in the relief of GERD symptoms and healing of erosive oesophagitis. The safety profile of the proton pump inhibitors in children is excellent with no significant adverse events observed either in the short‐ or long‐term (&gt;5.5 years continuous use). Finally, surgical procedures for GERD may also be indicated in certain circumstances.

Review article: update on gastro‐oesophageal reflux disease in children

综述文章：儿童胃食管反流病的最新进展

Summary Major points of controversy identified by the workshop included: (i) symptom assessment of acid‐related disorders in children, where vomiting was identified as a potential confounding feature, abdominal pain as a common feature of paediatric gastro‐oesophageal reflux disease; (ii) extra‐oesophageal manifestations of paediatric gastro‐oesophageal reflux disease; (iii) abdominal pain perceived as a common feature of Helicobacter pylori ‐related disorders; (iv) role of testing for H. pylori in children; (v) test‐and‐treat strategies for H. pylori infection in children before long‐term proton pump inhibitor therapy; (vi) an underutilization of triple therapy and proton pump inhibitors in children in areas with a high prevalence of H. pylori infection; (vii) the role of empiric proton pump inhibitor therapy in children.

F. K. L. Chan

B. D. Gold

Review article: issues in acid‐related disorders in children in Asian countries

综述文章：亚洲国家儿童酸相关疾病的若干问题

涉及主题	医学内科学生物胃肠病学化学遗传学生物化学病理外科幽门螺杆菌物理胃疾病免疫学内分泌学药理学有机化学心理学放射科
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基本数据	创刊年份: 2005，原创研究文献占比: 0.00%，自引率:N.A.， Gold OA占比: 0.00%
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