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Biomedical subjects

A Leodolter

Publications and source records attributed to A Leodolter.

At least 37 records · Page 2Linked to original sources
PubMed2002

Addition of glucose to a fatty meal delays chylomicrons and suppresses VLDL in healthy subjects.

BACKGROUND: Postprandial lipemia has been shown in a number of studies to be associated with atherosclerosis. However, the test meals used in these studies were heterogeneous particularly in their carbohydrate content, which may be important for the resulting lipemia and which makes comparison between different studies difficult. We studied the effect of 75 g glucose added to a fatty meal on various lipoproteins and on gastric emptying. MATERIALS AND METHODS: Fourteen healthy young volunteers were studied in the fasting state and until 7 h postprandially. In a crossover design, each subject received an oral fat load (1 g fat kg(-1) body weight) with or without 75 g glucose. Triacylglycerol (TG) and free fatty acids (FFA) were then measured in whole blood and lipoproteins were separated off by ultracentrifuging. Gastric emptying was determined by the (13)C breath test. RESULTS: The addition of 75 g glucose to a fatty meal had two different effects. Gastric emptying was delayed by about 2 h and the chylomicron response was consequently postponed. In addition, the postprandial increase in VLDL triacylglycerol was reduced by 40%, which may be due to the pronounced FFA depression during the glucose-induced rise in insulin. CONCLUSIONS: 75 g glucose added to an oral fat load causes a delay of the chylomicron response and a marked suppression of the postprandial increase in VLDL.

Adult↗
PubMed2002

[Epidemiology and pathogenesis of Helicobacter pylori infection].

Since Marshall and Warren reported the first isolation of Helicobacter pylori basic and clinical research on pathogenesis and epidemiology of Helicobacter pylori infection have been tremendous. Childhood is clearly established as the period of major risk for Helicobacter pylori acquisition. The transmission pathways may be several including the oral-oral, the gastro-oral or the fecal-oral transmission route. The colonization of Helicobacter pylori occurs exclusively in the gastric mucosa or in areas of gastric metaplasia especially in the duodenum. Helicobacter pylori possesses several factors to adhere to the epithelial cells and to cause mucosal damage. The acquisition of Helicobacter pylori always induces a chronic gastritis. The development to clinical manifestations (peptic ulcer or gastric cancer) are further dependent on specific bacterial strain virulence factors as well as on host and environment factors. The mechanisms involved in the inflammatory process have been elucidated in great detail and will further be focused and related to specific associated disease development.

Adult↗
PubMed2002

Prevalence of H. pylori-infection in family members of H. pylori positive and its influence on the reinfection rate after successful eradication therapy: a two-year follow-up.

INTRODUCTION: Living conditions (e. g. domestic crowding) may influence the infection rate. Some studies suggested that the reappearance of H. pylori in H. pylori positive patients after successful eradication therapy might be a result of transmission by H. pylori positive spouses. Therefore this study has been performed to evaluate the effect of the H. pylori status of family members on the reinfection rate of H. pylori positive patients after successful eradication therapy. METHODS: 108 H. pylori positive patients (64 male, 44 female, aged 48.7 years, range 18-76 years) who presented with dyspeptic symptoms for upper GI-endoscopy have been included into this study. H. pylori status has been defined by culture and/or histology, rapid urease test and serology. For eradication therapy patients received omeprazole 20 mg bd, clarithromycine 250 mg bd and metronidazole 400 mg bd. H. pylori status was controlled by (13)C-urea breath test 28 days (n = 96), 6 (n = 35), 12 (n = 28) and 24 months (n = 25) after eradication therapy. Additionally H. pylori status of 170 family members (82 spouses, 68 children, 20 siblings/parents, aged 3-83 years) was defined by (13)C-urea breath test (n = 167), upper GI-endoscopy (n = 2) or serology (n = 1). RESULTS: The eradication rate was 98 % (94/96). H. pylori prevalence in all family members was 40 % (56 % in spouses, 20 % in children). No reinfection has been found in successful eradicated patients within the two-years follow-up. DISCUSSION: These results suggest that reinfection is not dependent on the H. pylori prevalence in family members and that H. pylori reinfection after successful eradication therapy is an unlikely event.

Adolescent↗
PubMed2001

Comparative evaluation of two hemagglutination tests for the detection of anti-Helicobacter pylori antibodies.

Two hemagglutination assays (IHAs) for detecting anti-H. pylori antibodies were evaluated. In 257 patients, both tests revealed sensitivity or specificity values between 71-79% or 81-82%, respectively, which were lower than those of an anti-H. pylori ELISA. Notably, the sensitivities of both IHAs varied in subgroups of patients between 48-95%. Based on the validation, the IgG-ELISA is superior to both IHAs tested, and therefore, should be used in routine diagnostics.

Adolescent↗
PubMed2001

A meta-analysis comparing eradication, healing and relapse rates in patients with Helicobacter pylori-associated gastric or duodenal ulcer.

AIM: To compare the effectiveness of Helicobacter pylori eradication in curing peptic ulcer disease in trials involving both gastric ulcer and duodenal ulcer. METHODS: Twenty-four relevant randomized controlled trials and randomized comparative trials met the predefined selection criteria. Only proton pump inhibitor-based eradication trials were considered for the evaluation of eradication efficacy and ulcer healing. For the determination of relapse rates, all trials independent of the eradication therapy regimen were considered. RESULTS: Data from 2102 patients were analysed comparing gastric ulcer with duodenal ulcer. No statistical differences between gastric ulcer and duodenal ulcer patients were found with regard to eradication rates (summarized odds ratio, 1.23; 95% confidence interval, 0.98-1.55) or ulcer relapse rates, whether in successfully H. pylori eradicated patients (summarized odds ratio, 0.69; 95% confidence interval, 0.26-1.84) or unsuccessfully H. pylori eradicated patients (summarized odds ratio, 1.48; 95% confidence interval, 0.85-2.56). Owing to heterogeneity, healing rates were not comparable. CONCLUSIONS: The eradication of H. pylori infection cures both gastric and duodenal ulcer, and the cure rates are similar. This suggests that H. pylori is the key factor in peptic ulcer disease independent of the ulcer site.

Anti-Bacterial Agents↗
PubMed2001

A novel immunoassay based on monoclonal antibodies for the detection of Helicobacter pylori antigens in human stool.

BACKGROUND AND AIM: With the Premier Platinum HpSA EIAtrade mark a new enzyme immunoassay was developed for diagnosis of H. pylori infection, using polyclonal antibodies against H. pylori antigens in human stool. Here we evaluated FemtoLab H. pyloritrade mark based on the use of monoclonal antibodies in comparison to established reference methods. METHODS: 53 consecutive patients (27male, 26 female, age: 17-85 years) undergoing routine upper gastrointestinal endoscopy were enrolled in this study. The H. pylori status was determined by 4 reference methods: Histology, rapid urease test (HUT), (13)C-urea breath test ((13)C-UBT) and serology. Patients were considered to be infected with H. pylori if at least 2 of the 4 reference tests were positive. Stool samples were aliquoted after reception and stored frozen (-20 degrees C) until tested. The FemtoLab H. pyloritrade mark (Connex GmbH, Germany) and the Premier Platinum HpSA EIAtrade mark (Meridian, Connecticut, Ohio, USA) were performed according to the manufacturers protocols. RESULTS: 26 of the 53 patients were H. pylori infected. 3 were false-negative by the FemtoLab H. pyloritrade mark and one false-positive result was obtained (sensitivity 88,5 %, specificity 96,3 %). The concordance between the 2 stool tests was 94,3 % (50/53 cases). CONCLUSION: The diagnostic quality of the novel FemtoLab H. pyloritrade mark Enzyme Immunoassay is comparable with the established Premier Platinum HpSA EIAtrade mark. The differences between positive and negative results obtained with the FemtoLab H. pyloritrade mark are greater in comparison to the Premier Platinum HpSA EIAtrade mark and therefore this test system allows a better distinction.

Adolescent↗
PubMed2001

Validity of a Helicobacter pylori stool antigen assay for the assessment of H. pylori status following eradication therapy.

BACKGROUND: A Helicobacter pylori stool antigen (HpSA) test has been proposed as a valid alternative to the 13C-urea breath test (13C-UBT) for the non-invasive detection of H. pylori infection in primary diagnosis. Published reports show conflicting results with regard to the test's diagnostic accuracy after eradication therapy. The aim of the present study was to assess the diagnostic value of the HpSA test and to determine the optimal discriminating cut-off value in patients following H. pylori eradication therapy. METHOD: Stool samples were collected and the 13C-UBT was performed in 113 patients 4-6 weeks after eradication therapy. A validated test protocol for the 13C-UBT was used. Stool specimens were analysed with the Premier Platinum HpSA enzyme immunoassay (EIA). A receiver operator characteristics (ROC) analysis was performed to define the optimal cut-off value on the basis of the results of the 13C-UBT. RESULTS: The results of the 13C-UBT showed that H. pylori eradication was successful in 83/113 (73%) patients. According to the manufacturer, the cut-off value for the HpSA test is 0.14 optical density, but this does not appear to be valid after eradication therapy (sensitivity 76.7%, specificity 98.8%). On the basis of ROC analysis, the optimal cut-off value after therapy was determined to be 0.11 optical density, giving a sensitivity of 93.3% and a specificity of 93.9%. CONCLUSION: The HpSA test is a valid test for the assessment of H. pylori status after eradication therapy, provided an adjusted cut-off value is applied.

Adult↗
PubMed2001

Current standards in the diagnosis of Helicobacter pylori infection.

A large number of diagnostic tests are available for the diagnosis of Helicobacter pylori infection. These diagnostic methods include invasive and noninvasive methods. Culture yields the highest specificity and moreover allows the determination of strain resistance against antibiotics. Histology besides detection of H. pylori allows to assess morphological changes of the gastric mucosa. In clinical practice, the rapid urease test is very convenient and highly accurate. The (13)C-urea breath test and the recently developed stool antigen test are reliable noninvasive tests with a high diagnostic accuracy in pre- and posttreatment conditions. Serological tests have a lower diagnostic accuracy and should only be used for screening of H. pylori infection or after careful local validation.

Antigens, Bacterial↗
PubMed2001

H. pylori infection and visceral hypersensitivity in patients with irritable bowel syndrome.

BACKGROUND/AIM: Irritable bowel syndrome (IBS) is characterized by abdominal pain and changes in stool habits. Visceral hypersensitivity (VH) is a key factor in the pathophysiology of IBS. The role of Helicobacter pylori infection in the induction of VH in the upper gastrointestinal tract is controversially discussed. The aim of this study is to evaluate the value of rectal barostat in eliciting abdominal symptoms in patients with IBS in relation to H. pylori infection. PATIENTS AND METHODS: 31 patients (19 female, 12 male, mean age 45.6 +/- 10 years) with normal colonoscopy and clinical signs of IBS were examined by rectal barostat (pressure-controlled balloon distension in the rectum). Induction of typical abdominal discomfort (far from the balloon) defined the examination positive. Level of nonpainful perception (L1), feeling of defecation (L2), and pain or stool urgency (L3) were registered in comparison with a healthy control group (CG; n = 15, 9 female, 6 male). The H. pylori status was defined by (13)C-urea breath test (n = 46). RESULTS: Typical abdominal discomfort was induced in 9 patients (pain group, PG) by pressure-controlled rectal distension (H. pylori status: 8 positive, 1 negative). Patients not presenting with abdominal pain to rectal distension (nonpain group, NPG) were all H. pylori negative (p < 0.001). L3 as an indicator of VH was reached at a lower pressure threshold in PG than in NPG or CG (p < 0.05). The perception was not different between NPG and CG (p > 0.05). CONCLUSIONS: The induction of typical abdominal discomfort in patients with IBS by the use of rectal barostat occurred predominantly in H. pylori infected patients and suggests that H. pylori infection may be involved in triggering VH in patients with IBS. Further studies in larger patient groups and after H. pylori eradication therapy are needed to confirm and extend this observation.

Abdominal Pain↗
PubMed2001

Helicobacter pylori and gastric cancer:current status of the Austrain Czech German gastric cancer prevention trial (PRISMA Study).

AIM: To test the hypothesis that Helicobacter pylori eradication alone can reduce the incidence of gastric cancer in a subgroup of individuals with an increased risk for this fatal disease. METHODS: It is a prospective, randomized, double blind, placebo controlled multinational multicenter trial. Men between 55 and 65 years of age with a gastric cancer phenotype of Helicobacter pylori gastritis are randomized to receive a 7 day course of omeprazole 2 X 20mg, clarithromycin 2 X 500mg, and amoxicillin 2 X 1g for 7 days, or omeprazole 2 X 20mg plus placebo. Follow-up endoscopy is scheduled 3 months after therapy, and thereafter in one-year intervals. Predefined study endpoints are gastric cancer, precancerous lesions (dysplasia, adenoma), other cancers, and death. RESULTS: Since March 1998, 1524 target patients have been screened, 279 patients (18.3%) had a corpus dominant type of H. pylori gastritis, and 167 of those were randomized (58.8%). In the active treatment group (r = 86), H. pylori infection infection was cured in 88.9% of patients. Currently, the cumulative follow-up time is 3046 months (253.38 patient years, median follow up 16 months). So far, none of the patients developed gastric cancer or any precancerous lesion. Three (1.8%) patients reached study endpoints other than gastric cancer. CONCLUSION: Among men between 55 and 65 years of age, the gastric cancer phenotype of H. pylori gastritis appears to be more common than expected. Further follow up and continuing recruitment are necessary to fulfil the main aim of the study.

Amoxicillin↗
PubMed2001

[Healing peptic ulcer disease with therapy of Helicobacter pylori infection--an overview].

Over the last 15 years several new aspects in the pathogenesis and basic changes in therapeutic strategies for healing of peptic ulcers have been introduced. The discovery of Helicobacter pylori, the possibility of treatment of the infection and consecutive healing of peptic ulcer disease have changed the understanding of the pathophysiology of the peptic ulcer disease. Most gastric or duodenal ulcers are based on Helicobacter pylori infection. Newer therapeutic strategies to cure Helicobacter pylori infection consist of proton pump inhibitor (PPI) based triple therapy, containing in addition two antibiotics chosen from clarithromycin, amoxicillin and metronidazole, administered over 7 days. The other main cause of gastroduodenal ulcers are non-steroidal antirheumatic drugs or aspirin intake. PPI are therapeutic strategies of choice for treatment of such lesions. Main topics of this overview are the principles and the therapeutic proceeding in the management of Helicobacter pylori-associated peptic ulcer disease. The differences between duodenal and gastric ulcer are especially dealt with.

Anti-Bacterial Agents↗
PubMed2000

Cure of Helicobacter pylori-associated ulcer disease through eradication.

The eradication of Helicobacter pylori (H. pylori) infection has led to a dramatic benefit for patients with gastroduodenal ulcer disease, as the majority of these patients receive a lifelong cure. Relapses after successful H. pylori cure may be caused by either recrudescence or reinfection, both rare events nowadays, or be attributed to non-steroidal anti-inflammatory drugs or aspirin intake. In certain geographical areas, H. pylori-negative relapses are proposed as a new, pathophysiological and not yet elucidated entity. The cure of H. pylori infection in uncomplicated duodenal ulcer diseases consists of 7 days of proton pump inhibitor (PPI) based triple therapy, containing two antibiotics from clarithromycin, amoxicillin and metronidazole. In gastric ulcer, it is recommended that the PPI is continued for a further 3 weeks as these ulcers have a prolonged healing time. Rescue therapies after failure need to take into consideration the resistance pattern of the micro-organism and are offered in the form of quadruple therapy or a high-dose PPI with amoxicillin.

Anti-Bacterial Agents↗
PubMed2000

13C-octanoic acid breath test for gastric emptying measurement.

OBJECTIVES: The purpose of this multicentre study was to assess the accuracy and reproducibility of the 13C-octanoic acid breath test compared to scintigraphy for measurement of gastric emptying. METHODS: Sixty-nine healthy subjects (40 men, 29 women; mean age 30 years, range 21-61) were studied at least once by using the 13C-octanoic breath test. In 34 healthy subjects, gastric emptying was simultaneously measured by gastric scintigraphy, and the 13C-octanoic breath test was then repeated in 18 of these cases. Fifty-four patients (30 men, 24 women; mean age 46 years, range 13-74) with dyspeptic or reflux symptoms were studied according to the same procedure. RESULTS: The correlation between breath test and scintigraphic values was highly significant (r = 0.744, P<0.001). The concordance of results of scintigraphy and breath test (normal versus abnormal) and the reproducibility (Bland and Altman method) of the breath test were good (CVinter = 24%, CVintra = 15%). As compared to scintigraphy, breath test detected an abnormal gastric emptying with 67% sensitivity and 80% specificity (ROC analysis). CONCLUSION: These results confirm the value of breath test as an accurate measurement of gastric emptying. Its excellent reproducibility makes it a method of choice for pharmacological studies. However, at least when scintigraphy is considered the gold standard, breath test sensitivity may be insufficient for the detection of gastroparesis in an individual patient.

Adolescent↗
PubMed2000

Comparison of two tubeless function tests in the assessment of mild-to-moderate exocrine pancreatic insufficiency.

BACKGROUND: Faecal elastase 1 (FE1) and the pancreolauryl test (PLT) are widely used for the non-invasive diagnosis of exocrine pancreatic insufficiency (EPI). Whether one of these two tests is superior for the detection of mild-to-moderate EPI is the subject of controversy. The aim of this study was to compare the diagnostic performance of the PLT and FE1 for the detection of EPI in patients with chronic pancreatitis. METHODS: Forty consecutive patients (27 males, 13 females, 23-72 years) with chronic pancreatitis based on imaging procedures (computed tomography, endoscopic retrograde pancreatography and endoscopic ultrasound) were admitted to the study. A secretin-caerulein test (SCT) was performed after an overnight fast by giving secretin (1 U/kg/h) and caerulein (100 ng/kg/h) intravenously over 90 min. Duodenal contents were aspirated at 15 min intervals and analysed for pH, bicarbonate, amylase, lipase and elastase. EPI was graded on the basis of the results of the SCT as absent, mild, moderate or severe. A serum PLT was performed in accordance with a modified protocol previously described. A commercial ELISA was used for determination of FE1. The cut-off values were > or = 4.5 mg/l for PLT and > or = 200 microg/g for FE1. and 13 severe) on the basis of the results of the SCT. The sensitivity of the PLT for diagnosing EPI of all degrees of severity was 82% (27/33), compared with 50% for FE1 (16/ 33). In patients with severe EPI, the PLT was abnormal in 100% (13/13) and FE1 was abnormal in 85% (11/13) of the cases. The sensitivity decreases for both tests in the group of mild/moderate EPI (PLT 70% (14/20), FE1 35% (7/20)). In all seven patients with normal exocrine pancreatic function, both PLT and FE1 were also normal. CONCLUSIONS: The PLT is more sensitive than FE1 for the diagnosis of mild-to-moderate EPI, and is therefore more appropriate for completing the staging of chronic pancreatitis.

Adult↗
PubMed2000

alpha-catenin expression is decreased in human gastric cancers and in the gastric mucosa of first degree relatives.

BACKGROUND AND AIMS: The role of altered cell adhesion is critical for the development of epithelial cancers. E-cadherin plays an important role in the maintenance of cell-cell adhesion and its function is thought to be regulated by its associated cytoplasmic proteins, such as alpha-catenin and beta-catenin. To determine the role of alpha-catenin expression in gastric carcinogenesis, we studied its expression in human gastric cancer and in the gastric mucosa of first degree relatives with no clinical disease. METHODS: alpha-Catenin expression was assessed by immunohistochemical analysis and reverse transcriptase-polymerase chain reaction (RT-PCR) using gastric tissue specimens from patients with gastric cancer and from the gastric mucosa of first degree relatives of gastric cancer patients and healthy controls. RESULTS: mRNA levels of alpha-catenin were reduced or absent in 13 of 19 gastric cancer tissues, which differed significantly from levels found in the tumour free gastric mucosa of cancer patients (p<0.05). Of the cancer samples with altered alpha-catenin mRNA levels, alpha-catenin expression was negative in seven and decreased in six cases. Interestingly, decreased alpha-catenin mRNA expression also occurred in the mucosa of the corpus (11/18) and antrum (4/18) of first degree relatives. In the corpus biopsies alpha-catenin expression was more often decreased or lost compared with the antrum biopsies in first degree relatives and healthy controls (p<0.05). Immunohistochemical analysis revealed membranous expression of alpha-catenin in gastric cancer cells and the non-malignant gastric epithelium. However, some cancers also exhibited loss of membranous staining. Generally, loss or downregulation of alpha-catenin mRNA in the gastric mucosa was associated with Helicobacter pylori infection (p<0.05). CONCLUSION: Our findings suggest that loss or downregulation of alpha-catenin expression may be an early event in gastric carcinogenesis and may be associated with H pylori infection.

Adult↗
PubMed1999

Citric acid or orange juice for the 13C-urea breath test: the impact of pH and gastric emptying.

BACKGROUND: There is an ongoing debate about the optimal test drink to be used in the 13C-urea breath test (13C-UBT). We recently reported that a citric acid solution is the optimal test drink in the 13C-UBT, because it provides a high 13CO2 recovery and the excellent accuracy of the test appears optimal compared to other test meals. Orange juice, because of a better taste, is also propagated as a test drink in the 13C-UBT. AIM: To compare the diagnostic accuracy of the 13C-UBT with either orange juice or citric acid solution as a test drink. Furthermore, the effect of these test drinks on the gastric emptying rate was determined. METHODS: H. pylori status was assessed by histology, rapid urease test and culture in 50 consecutive dyspeptic patients. A 13C-UBT was performed on two consecutive days by giving 75 mg of 13C-urea randomly dissolved in 200 mL 0.1 M citric acid solution or 200 mL orange juice. The 13CO2/12CO2 ratio was measured in breath samples taken before and 15, 30, 45 and 60 min after administration of the test drink. The gastric emptying rate of orange juice and citric acid solution was compared to that of water in 10 healthy subjects on three consecutive days by means of a 13C-sodium acetate breath test; 50 mg of 13C-sodium acetate was dissolved in 200 mL of each solution and breath samples were collected before and every 10 min for 90 min after administration of the test drink. RESULTS: Twenty-six out of 50 patients (52%) were infected with H. pylori. Significantly higher values over baseline (35.7+/-5.2 per thousand vs. 23.2+/-3.4 per thousand, P<0.001) and higher area under the curve (1507+/-198 vs. 927+/-128, P<0.001) were observed in H. pylori-positive patients when citric acid solution was administered compared with orange juice. Sensitivity of the 13C-UBT was 100% when citric acid was used as a test drink and 88% with orange juice. Specificity was 100% with both test drinks. Gastric emptying of citric acid solution (t1/2 = 60.9+/-3.5 min) was significantly slower than that of orange juice (t1/2 = 49.7+/-3.1 min, P<0.001). CONCLUSION: 13C-UBT loses diagnostic accuracy when orange juice instead of citric acid is used as a test drink. The faster gastric emptying of orange juice might be responsible for the lower diagnostic accuracy of the 13C-UBT.

Adult↗