Search

Background and aims: The success of Helicobacter pylori eradication regimens depends on gastric pH, inflammation, and mucus thickness. Our aim was to investigate the effects of acid secretion, inflammation, and [...]

Divisions of Gastroenterology and Pathology, University Hospital, Nottingham NG7 2UH, UK Introduction: Entero-endocrine (EC) cells are neuro-endocrine cells found throughout the GI tract, which store and secrete serotonin and other [...]

P.V Sherwood [1] J.I.D. Wibawa [2] D.A. Barrett [2] P.N. Shaw [2] D. Jenkins [3] R.C. Spiller [1] Depts of (1.) Gastroenterology (2.) Pharmaceutical Sciences and (3.) Pathology, University Hospital, [...]

Differential lymphocyte and plasma cell counts and measurements of mucosal architecture were studied in small intestinal biopsies from 17 controls and 17 patients with untreated uncomplicated coeliac disease of whom five also had dermatitis herpetiformis. Intraepithelial T-cell and plasma cell counts and measurements of mucosal architecture were not significantly different in the two coeliac groups but both groups differed from the controls. Lamina propria T-cell counts were significantly higher in the patients who also had dermatitis herpetiformis than in uncomplicated coeliac disease, with a significant increase in the Leu 2 (CD8) positive (cytotoxic/suppressor) T-cell subset. This suggests a specific abnormality of T-cell control of immune responsiveness in the pathogenesis of the skin manifestations of dermatitis herpetiformis which is not found in uncomplicated coeliac disease. [ABSTRACT FROM PUBLISHER]

Counts of T-lymphocytes within surface and crypt epithelium and lamina propria of normal and coeliac small intestinal mucosa using an immunoperoxidase method are described and related statistically to changes in mucosal structure determined by quantitative histology. The use of multiple pan-T-lymphocyte and subset antibodies allowed comparison of marker patterns in normal and abnormal mucosa. Total numbers of surface epithelial T-lymphocytes and subtypes were not found to be increased in coeliac disease, but there was an increase in density per unit length of epithelium. Distinctive changes in expression of Leu 1, Leu 2, and Leu 5 by the surface epithelial T-lymphocytes suggest that, although their total numbers are not increased, these cells are not passively crowded but have an active role, possibly as committed cytotoxic lymphocytes. Natural killer cells do not appear to be a major population in normal or coeliac small intestinal mucosa. [ABSTRACT FROM PUBLISHER]

Using an immunoperoxidase technique IgA, IgM, IgE and IgG plasma cells were studied in endoscopic duodenal bulb biopsies taken from 14 controls, 25 patients with grade 1 duodenitis (Whitehead classification), 12 patients with grade 2 duodenitis and three with grade 3 duodenitis. The control counts were compared with those in the jejunum and rectum. In addition cell counts were compared in 16 pairs of patients, with and without duodenal ulcer, exactly matched for grade of duodenitis. The control counts were not significantly different from counts in jejunum or rectum except for IgG which were higher in the jejunum (p = 0.03). IgA plasma cell counts were significantly increased in both grade 1 and grade 2 duodenitis compared with controls (p less than 0.05 and p less than 0.01). There was no significant difference for the other plasma cells. All plasma cell counts were decreased in the small group of grade 3 duodenitis compared with the other groups. There was no significant difference between counts in duodenitis whether or not there was associated duodenal ulceration. The isolated IgA plasma cell response of the duodenal bulb mucosa in duodenitis is very different from that of the jejunal mucosa in coeliac disease, and the rectal mucosa in inflammatory bowel disease and bacterial colitis and probably represents the basic response to any mucosal damage. [ABSTRACT FROM PUBLISHER]

Using a modified immunoperoxidase technique to achieve optimum staining and reproducible counts of plasma cells in paraffin embedded tissue, IgA, IgM, IgE, and IgG plasma cells were studied in small bowel biopsies from 20 controls, 23 untreated coeliac patients, 19 treated coeliac patients, and seven patients with Crohn's disease not involving duodenum or jejunum. In controls the ratio of the mean counts for IgA, IgM, IgE, and IgG plasma cells was 2.5:1:1:1 respectively. In patients with untreated coeliac disease, counts of all types of plasma cell were significantly increased approximately two-fold compared with controls although for IgG cells there was considerable overlap. The ratio of the mean plasma cell counts in the untreated coeliac patients was 3.5:1.5:2:1. Counts fell significantly after treatment with a gluten-free diet. There was no significant difference between counts in the controls and the Crohn's disease patients. The changes found in coeliac disease may simply be a non-specific response to mucosal damage. The increases in IgA and IgM plasma cells, however, suggest that the deposits of extracellular IgA and IgM observed in coeliac mucosa are locally produced, and the increase in IgE plasma cells raises the possibility that reaginic type hypersensitivity may be involved in coeliac disease. [ABSTRACT FROM PUBLISHER]

To achieve optimum staining and reproducible counts of plasma cells in paraffin embedded tissue with the immunoperoxidase technique we have found it essential to obtain a plateau count by titration of antisera for each specimen. This modification was used to study IgA, IgM, IgE, and IgG plasma cells in rectal biopsies from 20 controls, 20 patients with ulcerative proctocolitis, 20 with Crohn's colitis, 20 with non-specific proctitis, 15 with bacterial colitis, and seven with Crohn's disease but no apparent large bowel involvement. Counts were correlated with the characteristic histological features of inflammatory bowel disease. In controls the ratio of the mean counts for IgA, IgM, IgE, and IgG plasma cells was 8:3:3:1. All types of plasma cells were very significantly increased in the patients with ulcerative proctocolitis, Crohn's colitis, and non-specific proctitis and counts correlated with the severity of inflammation. There was no significant difference between the counts in these three groups. All counts tended to be higher in bacterial colitis than in controls, the difference being significant for IgA and IgE. When matched for severity of inflammation there was no significant difference between the counts in bacterial colitis and inflammatory bowel disease. The counts in patients with Crohn's disease but no large bowel involvement were not significantly different from controls. These results suggest that changes in plasma cell counts in inflammatory bowel disease are a non-specific response to mucosal damage, possible by a luminal irritant, and do not differentiate the type of inflammatory bowel disease. [ABSTRACT FROM PUBLISHER]

Pectin has been shown to minimise the fall in blood glucose seen in patients who are troubled by hypoglycaemia attacks after gastric surgery. We therefore performed 50 g glucose tolerance tests with and without 14.5 g pectin on 11 post-gastric surgery patients. After pectin, the high postprandial levels of glucose, insulin, and enteroglucagon were significantly reduced as was the fall in blood glucose between 90 and 120 minutes. These effects of pectin may reflect slower uptake of glucose from the gastrointestinal tract and provide evidence to support the use of unabsorbable carbohydrate gelling agents in treating hypoglycaemia after gastric surgery. [ABSTRACT FROM PUBLISHER]

A new method is described for measuring the mean transit time (MTT) of digesta through the human gut in which a constant amount of marker (radio-opaque pellets) is fed to subjects with each meal over a period of weeks, and its excretion measured in the stools. The MTT measured by this method (MTT-C) has been compared with MTT measured by giving single doses of similar markers to the same subjects (MTT-S) and with the 80% transit time (80% TT). Mean values on three dietary regimes for the MTT-C (54.2 h +/- 2.5) and MTT-S (54.2 +/- 2.6) were lower than that for 80% TT (63.1 +/- 3.0). The average MTT-C in a group of six healthy young men on an ad libitum diet was 2-3 days (range 0-7-4-0). When additional dietary fibre was added to a standard diet the average MTT-C fell (in all of five subjects) from 2-4 to 1-6 days. A continuous record of MTT-C is obtained by this new method which shows wide variations from week to week even on controlled dietary intakes. Using the single dose technique, evidence is produced which suggests that the MTT-S is a more accurate and reproducible method than the 80% TT. [ABSTRACT FROM PUBLISHER]

A prospective search for gastro-oesophageal candidiasis was made by histological examination of all the biopsies taken from 465 patients endoscoped consecutively during a 12 month period. The criterion for diagnosis was the demonstration of infiltration of tissue or ulcer slough by yeasts and hyphae. Nineteen cases of candidiasis were found giving an overall incidence of 4%. There were 12 cases with oesophageal candidiasis, two with both oesophageal and gastric candidiasis, and five with gastric candidiasis. In none of the patients was candidiasis suspected before endoscopy. Symptoms referable to the candidiasis were uncommon and radiology was not helpful in diagnosis. There was associated local pathology (particularly peptic ulceration and carcinoma of the stomach or oesophagus) in all except two patients, which suggests that the candidiasis is usually secondary to mucosal damage. In the series, candidiasis was present in 27% of patients with oesophageal cancer, 20% of patients with gastric cancer, 16% of patients with benign gastric ulcers, and 15% of patients with oesophagitis. [ABSTRACT FROM PUBLISHER]

Background: Galanin is a neuropeptide distributed widely throughout the central and peripheral nervous system. In particular, its presence has been demonstrated in dorsal root ganglia, spinal dorsal horn neurones and enteric nerves. It is known to have a modulatory function on nociception and peripheral nerve injury has been shown to upregulate its synthesis. We have previously shown that resection sections for complicated diverticular disease shown evidence of neural damage and regeneration within the enteric nervous system (ENS). Aim: To quantify the level of galanin expressed by mucosal nerves in patients with symptomatic and asymptomatic diverticular disease. Method: Ten symptomatic and ten asymptomatic patients underwent flexible sigmoidoscopy and multiple peridiverticula biopsies were obtained. Standard fluorescent immuno-histochemical methods were used. Mucosal nerves were identified using PGP9.5 and peripherin. Using digitised image analysis, the level of galanin immunoreactivity within mucosal nerves was expressed as percentage area of lamina propia. Results: Median age was 68.5 years (range 49-70) with no difference between groups. Symptomatic patients experienced recurrent abdominal pain on a median of 6 (range 3-12) days/month. Duration of the pain was 4 (0.75-12) hours. No pain was experienced by the asymptomatic group. The percentage area of galanin immunoreactivity within the lamina propia was 0.155% in symptomatic patients compared with 0.004% in controls (p < 0.0001 Mann-Whitney). Conclusion: There is an increased expression of galanin within colonic mucosal nerves in patients with painful diverticular disease. Although the direct effect of this change in the development of abdominal pain is as yet unclear, the increased expression implies previous or ongoing injury to the ENS in symptomatic patients, possibly due to inflammation. [ABSTRACT FROM AUTHOR]