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Background: The importance of coinfection of Helicobacter pylori (H.pylori) and Candida albicans (C. albicans) in the development of gastric diseases is not known. In this study, the frequency of concurrent infection of H. pylori and C. albicans in dyspeptic patients was assessed while considering age, gender, and PPI consumption of patients., Methods: Gastric biopsies were taken from 74 yeast-positive dyspeptic patients and gastric disease, age, gender, and proton pump inhibitor (PPI) consumption of subjects were recorded. One antral biopsy was used for rapid urease test (RUT) and one for H. pylori and yeast cultivation and smear preparation. Bacterial isolates were identified according to spiral morphology and the biochemical characteristics. Yeast isolates were identified on Chromagar and by the Nested-PCR amplification of C. albicans-specific topoisomerase II gene. Twenty-seven biopsy smears were Gram-stained and examined by the light microscope for observing H. pylori and yeast cells., Results: Fifty-four (73%) of patients were >40 year. Of 68 patients with PPI consumption record, 46 (67.6%) consumed PPI (p = 0). Comparison of patients in peptic ulcer group (12, 16.2%) with (6, 8.1%) or without (6, 8.1%) H. pylori or in gastritis group (62, 83.8%) with (25, 33.8%) or without (37, 50%) H. pylori showed no significant difference (p > 0.05). Of the 46 patients who consumed PPI, 13 (17.5%) were H. pylori-positive and 33 (44.6%) H. pylori-negative (p = 0). Ten out of twenty-seven smears showed the occurrence of H. pylori cells, including three with yeast cells. Of the 17 H. pylori-negative smears, three showed the occurrence of yeast cells only. Yeasts stained Gram-positive or Gram-negative and appeared as single or budding cells., Conclusion: The older age and PPI consumption could favor fungal colonization in the human stomach. The occurrence of a considerable number of H. pylori-positive or H. pylori-negative patients with gastritis or peptic ulcer shows that co-infection of Candida and H. pylori or infection of yeast alone could be associated with dyspeptic diseases. The occurrence of yeast cells in gastric biopsies with different Gram's reactions indicates that fungi might change their cell wall components for establishing a persistent colonization in the stomach.

Serum pepsinogen I and II are considered as indicators of changes in gastric morphology. Important publications from the last decades are reviewed with regard to the serum level of these biomarkers for the diagnosis of normal gastric mucosa, diffuse gastritis and its change to atrophic gastritis and intestinal metaplasia as well as gastric cancer. Due to the low sensitivity of serum biomarkers for diagnosis of gastric cancer, especially at its early stage and the poor prognosis of the tumor at the time of diagnosis, its prevention by eradication of H. pylori remains the mandatory strategy. On the other hand, the severity of regression and non-reversibility of precancerous lesions and intestinal metaplasia in gastric mucosa through eradication of H. pylori make it necessary to diagnose diffuse gastritis at its early stage. Increased serum pepsinogen II compared to normal serum pepsinogen I seems to indicate the presence of diffuse gastritis without precancerous lesions suitable for eradication of H. pylori infection, when it is serologically positive. A diagram illustrates the strategy of this therapeutic measure depending on the age of people and the level of serum biomarkers in areas with high gastric cancer prevalence.

Gastric cancer is a heterogeneous disorder; genetic factors, H. pylori infection and various environmental factors contribute to its development. Advanced atrophic corpus-predominant gastritis provides the histological base for its genesis. Low socio-economic status and poor hygienic conditions, smoking habits, heavy alcohol consumption, high salt and low intake of vegetables and fruits are important external factors for the occurrence of gastric cancer. For its prevention, the eradication of H. pylori infection at an early age is mandatory for subjects at high risk or those living in areas with high prevalence of gastric cancer. Given that an increased serum level of Pepsinogen II is a good biomarker for the presence of gastritis, it seems reasonable to screen all infected subjects at risk of gastric cancer with increased serum pepsinogen II at an early age (at around 30 years) to eradicate H. pylori. An endoscopy should be performed for subjects at an older age (40 years and older), when increased serum pepsinogen II level is associated with decreased serum pepsinogen I and pepsinogen I to II ratio.

Background: Current diagnosis of Helicobacter pylori infection by biopsy-based tests requires invasive sampling. Non-invasive methods such as the H. pylori stool-antigen (HpSA) test may be the best alternative for diagnosis of active infection. However, due to the presence of antigenic-diversity among the strains, various commercial tests have shown some discrepancies in different geographical-areas., Objectives: This study evaluates a homemade HpSA kit developed by using the H. pylori antigens from Iranian-isolates for detection of H. pylori in the stool of infected patients., Patients and Methods: Based on the endoscopic features and/or a rapid-urease test (RUT), 30 child and 50 adult patients, were recruited. From these candidates, three biopsies for RUT, culture and histology, and a stool-sample, were obtained. Patients were considered as H. pylori-positive if culture alone or RUT plus histology were found to be positive. Presence of H. pylori antigens in their stools was detected by the homemade HpSA test and an imported HpSA kit (Immundiagnostik, Germany)., Results: Using the biopsy-based tests with RUT, histology and culture, 53% (16/30) of children were diagnosed as H. pylori-positive while using the imported kit 57% and the homemade kit 50% of the candidates showed positive results. Also by the biopsy-based tests, 54% of the adults were diagnosed as H. pylori-positive while by the homemade kit 56% showed positive results. Considering the biopsy-based tests as the gold standard, sensitivity and specificity for the imported kit was 94% and 86%, respectively, while the mean sensitivity and specificity for the homemade kit was 96% and 98%, respectively., Conclusions: The homemade kit, compared with the imported kit and biopsy-proven tests may be a valid and reliable method for determining the presence of H. pylori infection in Iran.

Background: The aim of this investigation is to study the relationship between gastric morphology and serum biomarkers before and after Helicobacter pylori eradication., Methods: First-degree relatives of gastric cancer patients underwent gastroscopy before and 2.5 years after H. pylori eradication. The morphological changes in two categories (normal to mild and moderate to severe) were compared with level of pepsinogens I and II before eradication (n = 369), after eradication (n = 115), and in those with persistent infection (n = 250)., Results: After eradication, pepsinogen I decreased to 70% and pepsinogen II to 45% of the previous values. Unlike pepsinogen II and pepsinogen I to II ratio that were affected by the severity of inflammation and atrophy in corpus in all groups, pepsinogen I generally did not change. After eradication, subjects with high mononuclear infiltration in corpus had lower pepsinogen I (54 versus 77.1 μ/mL), higher pepsinogen II (9.4 versus 6.9 μ/mL), and lower ratio (7.9 versus 11.6) than those without (P < 0.05)., Conclusion: Pepsinogen II is a good marker of corpus morphological changes before and after H. pylori eradication.

Background: Helicobacter pylori (H. pylori)-specific genotypes have been closely correlated with an increased risk of gastric cancer (GC). The present study aimed to determine the distribution of H. pylori pathogenic genotypes amongst Iranians infected with strains representing European ancestry in areas with different GC incidence. , Methods: A total of 138 H. pylori isolates from ten districts in Iran were used for genotyping. , Results: The following genotypic frequency was observed: vacA s1 (94.9%), s2 (5.1%), m1 (24.6%), m2 (75.4%), d1 (39.9%), d2 (60.1%), i1 (40.6%), i2 (59.4%), iceA1 (76.8%), iceA2 (52.9%), iceA1/2 (29.7%), babA2 (40.6%), and cagA (65.9%). Hierarchical analyses of molecular variance (AMOVA) for the vacA d1, d2, i1, and i2 alleles and iceA1 and iceA1/2 genes found significant levels of genetic differentiation among populations (P < 0.05). Prevalence of the vacA d1, i1, and iceA1/2 (but not iceA1) genes and vacA d1/i1, vacA d1/iceA1, vacA d1/iceA1/2, vacA d1/cagA+, vacA i1/iceA1, vacA i1/iceA1/2, and vacA i1/cagA+ genotypes were significantly higher (>2- or 3-fold) among H. pylori isolates from high incidence GC areas that had age-standardized rates (ASRs) of >20/105 (max. 51.8/105) when compared with those from low incidence (ASRs <10/105) GC areas (P < 0.005, for the latter, P = 0.016). In contrast, the vacA d2/i2, m2/d2, and m2/i2 genotypes were significantly more prevalent in low compared to high incidence GC areas (P < 0.005). The results of Mantel's test only showed a low correlation between genetic and geographic distances for the iceA1 and iceA1/2 (but not vacA alleles, iceA2, babA2, and cagA) genes among ten districts of Iran (r = 0.098 and 0.074, respectively, P < 0.05). , Conclusions: We propose that the H. pylori vacA d1/-i1 genotypes, which are new determinants of GC, have tremendous potential for differentiating H. pylori strains from high and low incidence GC areas in Iran.

Background: Northern Iran (Ardabil) is characterized by a high gastric cancer (GC) rate, whereas Southern Iran (Kerman and Yazd) has a low GC rate. The aim of this study is to verify the potential for pepsinogen I and II to detect atrophic gastritis (AG) in both high and low risk populations for GC., Methods: Sera of blood donors and patients with GC from Ardebil, Kerman and Yazd were used to measure levels of pepsinogen I, II and H. pylori IgG antibody. GC rates in these cities were determined according to the Cancer Registry and upper gastrointestinal (GI) endoscopy results. , Results: There were 449 subjects with an average age of 45 ± 15 years. The GC rate in the endoscopy units of the hospital in Ardabil was four times higher than Kerman or Yazd. The mean serum pepsinogen I levels did not differ between Ardabil (102 ± 42.6 µg/mL), Kerman (103.3 ± 49.8 µg/mL), and Yazd (111.7 ± 39 µg/mL). Pepsinogen II levels were: 8.1 ± 4.7 µg/mL (Ardabil), 7.5 ± 5.3 µg/mL (Kerman), and 7.6 ± 4.4 µg/mL (Yazd), which were not different. The H. pylori infection rates were: Ardabil (61%), Kerman (55%), and Yazd (73%). A low ratio of pepsinogen I to II (≤3) was seen in Ardabil (1.3%), Kerman (1.9%), and Yazd (0.0%), which was not significant. A total of 51.9% of GC patients from Ardabil had normal pepsinogen I (≥70 µg/mL) levels and pepsinogen I/II ratios that were >5. , Conclusion: Serum biomarkers pepsinogen I and II and their ratios are probably not sensitive predictors of AG in areas that have either a high or low GC prevalence. This finding is likely related to the lack of an association between GC and advanced AG.

Background: Regression of precancerous lesions after H. pylori eradication remains controversial. This study evaluates the change and topography in first degree relatives (FDR) of gastric cancer (GC) patients following H. pylori eradication., Methods: Participants underwent endoscopy with antrum and corpus histological examinations. Subjects with pangastritis were randomly allocated to placebo or eradication therapy and followed over 4½ years. , Results: Among 989 evaluated FDR, we excluded 468 patients as follows: 108 had macroscopic lesions, 243 had no evidence of any H. pylori infection, and 117 were excluded for other reasons. The remaining subjects (n = 521) were allocated to therapy (group A, n = 261) or placebo (group B, n = 260) groups. Interim analysis of 403 subjects (201 placebo, 202 therapy) showed regression of atrophy (60 out of 97 in the antrum and 37 out of 104 in the corpus) in H.pylori-eradicated versus regression of atrophy (57 out of 184 in the antrum and 23 out of 173 in the corpus) in non-H.pylori-eradicated cases over 2½ years (P < 0.0001). No regression of intestinal metaplasia (IM) occurred in the antrum and corpus of treated subjects over 4½ years. However, progression of IM occurred in the antrum in 17 out of 90 patients in the non-H. pylori-eradicated versus 4 out of 68 H. pylori-eradicated subjects after 4½ years (P < 0.05)., Conclusion: Eradication of H. pylori is associated with regression of gastric atrophy but not IM, even in its early stages. Gastric atrophy and IM in the antrum have shown more rapid progression in cases not treated for H. pylori infection (over 4½ years follow-up) compared to H. pylori-eradicated cases.

We present the case of an 82-year-old man diagnosed with rectosigmoid cancer and liver metastasis who survived for 19 years following treatment. At the age of 64, the patient twice experienced mucus excretion for which he underwent a colonoscopy that resulted in a diagnosis of rectosigmoid cancer the patient underwent surgery for resection of the tumor and liver metastasis.  Histopathology was notable for a diagnosis of rectal adenocarcinoma that infiltrated the entire thickness of the wall, with metastasis to the liver and no lymph node involvement.  Post-operative chemotherapy was administered for about four months. The patient remained asymptomatic for 19 years which at that time he presented with liver metastasis, ascites and renal failure.

Background: Non-antifungal drugs appear promising in treatment of opportunistic infections of Candida spp. that are often resistant to current antifungals., Methods: The broth macrodilution method (NCCLS M27-P document) was used to compare the antifungal activity of trifluoperazine, propranolol, and lansoprazole with that of ketoconazole and amphotericin B, using 50 yeast isolates from the GI tract. The minimum fungicidal concentrations (MFCs), resistance rates and the time required for fungicidal activity of the drugs (2 - 48 hours) were determined., Results: The most effective antifungal activity was exhibited by trifluoperazine. Its MFC was 32 µg/mL for Candida albicans (3.3% resistance) and Candida spp. (0% resistance) yeasts, and 64 µg/mL for Candida tropicalis with 10% resistance. The MFC for C. albicans and Candida spp. was comparable to that of ketoconazole. However, the time required for the inhibitory effect (6 hr) was shorter than that of ketoconazole (48 hr) or amphotericin B (24 hr). The time required for the inhibitory activity on C. tropicalis was 24 hr, which was shorter than that of ketoconazole and amphotericin B (48 hr). A considerable number (40%) of Candida spp. showed resistance to ketoconazole, and 20% of C. tropicalis showed resistance to amphotericin B. Trifluoperazine, an antipsychotic drug, exhibited effective antifungal activity with the MFC, comparable to ketoconazole (32 µg/mL). Among the three yeast groups, C. tropicalis showed resistance to trifluoperazine and amphotericin B, and Candida spp. was considerably resistant to ketoconazole., Conclusion: Trifluoperazine could be considered as an alternative antifungal when encountering Candida spp. resistant to current antifungals.

Background: Scientific progress is an important indicator for the social and economic developments of any country. According to various reports, worldwide, Iran has the most growth in the field of science due to a high increase in the numbers of publications during the past decade. The aim of this study is to assess not only the quantity, but also the quality of publications of indexed Iranian journals and compare them to Turkey, as an Islamic neighboring country, in addition to the contributions of these two countries to our knowledge. A number of international journals with high impact factors were selected to assess the contributions of scientists from Iran and Turkey to the medical sciences., Methods: English medical journals from Iran and Turkey indexed by the ISI Web of Sciences with known impact factors (IF) announced at the beginning of 2010 were included for evaluation. We calculated the number of all articles published from the beginning of 2007 until the October 2010, the number of total citations, and citations from authors outside both countries for each journal. In addition, we selected all articles cited at least six times by authors outside of both countries and discussed their content with regard to originality and novelty, as well as their contributions to current knowledge. Furthermore, 60 international journals in basic or clinical research with IF greater than 6 were selected for the magnitude of contributions of both countries to our scientific knowledge., Results: In 2010, out of a total of 21 Iranian journals indexed in ISI since 2007, only 12 have a known IF with a mean of 0.39 (range: 0.07-0.97), whereas out of 28 Turkish medical journals indexed in ISI, 15 have a known IF (mean: 0.35, range: 0.05-0.82). The total number of articles published since 2007 from Iran, total citations and total citations by authors from outside Iran were 2080, 1218, and 463, respectively. The same data related to Turkish journals were 4876, 2036, and 1331, respectively. Indeed, the mean citations per article by foreign authors for Iranian and Turkish researchers were 0.19 and 0.3, respectively. Of the total articles during this period, only seven from Iran and nine from Turkey have been cited at least six times by authors outside the two countries. Iran had 23 and Turkey 37 original publications in highly reputable international journals. Turkey was more represented in basic research and clinical observational studies than Iran., Conclusion: Despite high numbers of published articles, both countries have medical journals with very low comparable citation rates and IF. Only one out of three Turkish articles is cited once by authors outside of Turkey and one of five Iranian articles is cited by authors outside Iran. The few high-cited articles address new therapies and interventional studies or diseases commonly encountered regionally, and are the results of the efforts of a few individuals in highly specialized fields. Turkish scientists are inclined to publish their scientific works more than Iranians in distinguished international journals. These articles deal more with regional diseases that are not common in Western countries. Developing countries can only contribute to world science when they focus their efforts on teamwork in order to research ways to solve country-specific diseases and their own health problems.

Background: Furazolidone is a much cheaper drug with a very low resistance against Helicobacter pylori compared to clarithromycin. We aim to evaluate safety and efficacy of a sequential furazolidone-based regimen versus clarithromycin-based therapy in H. pylori eradication for ulcer disease., Materials: Patients with proven peptic ulcer or duodenitis were randomized into three groups: OAB-M-F; metronidazole (M) (500 mg bid) for the first 5 days, followed by furazolidone (F) (200 mg bid) for the second 5 days; OAC-P; clarithromycin (C) (500 mg bid) for 10 days; and OAB-C-F; clarithromycin (500 mg bid) for the first 5 days and furazolidone (200 mg bid) for the second 5 days. All groups received omeprazole (O) (20 mg bid) and amoxicillin (A) (1 g bid). Groups OAB-M-F and OAB-C-F were also given bismuth subcitrate (B) (240 mg bid), whereas a placebo (P) was given to group OAC-P. Adverse events were scored and recorded. Two months after treatment, a C(13) -urea breath test was performed., Results: Three hundred and ten patients were enrolled and 92 (OAB-M-F), 95 (OAC-P), and 98 (OAB-C-F) completed the study. The intention-to-treat eradication rates were 78.5% (95% CI = 69-85), 81.1% (95% CI = 73-88), and 82% (95% CI = 74-89), and per-protocol eradication rates were 91.3% (95% CI = 83-96), 90.4% (95% CI = 82-95), and 88.7% (95% CI = 81-94), for group OAB-M-F, OAC-P, and OAB-C-F, respectively. Eradication rate differences did not reach statistical significance. The most common adverse event, bad taste, occurred in all groups, but more frequently in groups OAC-P (34%) and OAB-C-F (32%), than OAB-M-F (14%) (p < .05). Adverse symptoms score were 0.88 ± 2.05 in group OAB-M-F, 1.15 ± 1.40 in group OAC-P, and 1.87 ± 1.62 in group OAB-C-F., Conclusion: Furazolidone can replace clarithromycin in H. pylori eradication regimens because of lack of development of resistance and very low cost., (© 2010 Blackwell Publishing Ltd.)

Objectives: Studies on gastric mucosal histological findings among first degree relatives (FDR) of gastric cancer (GC) patients are scarce. The aim is to evaluate the topography and the severity of gastritis among FDR of GC patients., Design: A total of 989 subjects who were FDR of GC patients, ages 40-65 years underwent gastroscopies. When no gross lesion was found, five specimens were evaluated according to the Sydney Classification and one for urease testing in order to determine the type of gastritis and its severity., Results: Of the 989 subjects, 107 had significant lesions, including two with GC and one with esophageal cancer. The 864 subjects who had complete morphological data taken from five gastric areas (two from the antrum and three from the corpus) comprised 419 males (mean age 48.5±7 years) and 445 females (mean age 47±6.4 years). The H. pylori rate was 76.6%. Normal mucosa was seen in 6.9%, antrum-restricted gastritis in 7.4%, antrum-predominant gastritis in 63.5% and corpus-predominant gastritis in 20% (both had >80% H. pylori infection) and corpus-restricted gastritis in 2%. More atrophy was seen in the antrum and corpus of FDR females than males. The severity did not differ between those with one or more GC patients' relatives. Forty-nine percent of FDR had atrophy and 9.4% intestinal metaplasia (IM) in the corpus. After the age of 40, there was progression of intestinal metaplasia from 12.2 to 27.3% in the antrum and from 6.7% to 26.2% in the corpus during two decades. No high grade dysplasia was found in this mid-age population., Conclusion: Only one-fifth of FDR have H. pylori-induced corpus-predominant gastritis who are at risk for cancer and suitable for eradication. Corpus-restricted gastritis is a rare disease in this area.

The bacterium Helicobacter pylori colonizes the human stomach, with individual infections persisting for decades. The spread of the bacterium has been shown to reflect both ancient and recent human migrations. We have sequenced housekeeping genes from H. pylori isolated from 147 Iranians with well-characterized geographical and ethnic origins sampled throughout Iran and compared them with sequences from strains from other locations. H. pylori from Iran are similar to others isolated from Western Eurasia and can be placed in the previously described HpEurope population. Despite the location of Iran at the crossroads of Eurasia, we found no evidence that the region been a major source of ancestry for strains across the continent. On a smaller scale, we found genetic affinities between the H. pylori isolated from particular Iranian populations and strains from Turks, Uzbeks, Palestinians and Israelis, reflecting documented historical contacts over the past two thousand years.

Stool-antigen detection kits for diagnosis of Helicobacter pylori infection have been widely used because of their full non-invasive nature. Because Helicobacter pylori strains show a distinctive genetic diversity, it is important to find a protein that is a common antigen of various strains and shows a strong immunogenicity for the development of a stool- antigen detection kit. Alkyl hydroperoxide reductase (AhpC) of Helicobacter pylori strongly reacts with the sera of patients with gastritis and peptic ulcer. Therefore, AhpC seems to be an excellent candidate as a target protein for this study. Accordingly, polyclonal antiserum against AhpC was produced in adult New Zealand white rabbits by using AhpC in the gel bands without adding Freund's adjuvant. In addition, isolation and purification of AhpC were perfomed by preparative sodium dodecyl sulfate polyacrylamide gel electrophoresis and electroelution. In this study, a simple method was used for rapid production of polyclonal antibody against AhpC of H. pylori, which avoids both the long-term AhpC purification and the addition of Freund's adjuvant. One-dimensional preparative gel electrophoresis allows a single and short purification step; the high-resolution capacity of this technique leads to a high level of purity of the protein and consequently to a very high specificity of the antibody. Moreover, this method avoids contamination by other non-specific proteins, which often appear during the purification process by column chromatographic techniques, which may also decrease the purity of the immunogen. The present method is simple, rapid and cost-effective, and also makes it possible to produce antibody for stool-antigen enzyme immunoassay in a short time and at low cost.

A series of 5-(nitroaryl)-1,3,4-thiadiazoles bearing certain sulfur containing alkyl side chain similar to pendent residue in tinidazole molecule were synthesized and evaluated against Helicobacter pylori using disk diffusion method. The synthesized compounds were also evaluated for their antibacterial, antifungal and cytotoxic effects. Study of the structure-activity relationships of this series of compounds indicated that both the structure of the nitroaryl unit and the pendent group on 2-position of 1,3,4-thiadiazole ring dramatically impact the anti-H. pylori activity. While compound 7a containing 2-[2-(ethylsulfonyl)ethylthio]-side chain from nitrothiophene series was the most potent compound tested against clinical isolates of H. pylori, however, nitroimidazoles 6c and 7c were found to be more promising compounds because of their respectable anti-H. pylori activity besides less cytotoxic effects.

Smoking has not only enormous deleterious effects on cardiovascular, cerebral, and bronchial organs but also profoundly alters the function of all parts of the gastrointestinal tract through various mechanisms. Except the sole curiously observed benefit of smoking on the course of ulcerative colitis, it increases the prevalence of the common gastrointestinal diseases namely gastroesophageal acid reflux, peptic ulcer, and Crohn's diseases. It also increases the incidence of cancer of oral cavity, esophagus, stomach, pancreas, and liver mostly in a dose-response relationship and worsens the prognosis of colon cancer. The cessation of smoking is associated with the reduced incidence of cancer in the reported organs, but its effect on the regression of benign disease is not generally studied. The physicians must be aware not only of the harmful effect of smoking on the cardiovascular and bronchial systems, but also about the detrimental consequences of life-long smoking on the gastrointestinal tract and the increase of its benign and malignant diseases.

Background & Aims: First-degree relatives of gastric cancer patients are at risk for developing precancerous conditions. The aim of this study was to investigate the potential of biomarkers pepsinogen I (PGI), pepsinogen II (PGII), their ratio (PG I:II), as well as gastrin 17 for screening of precancerous conditions and corpus predominant gastritis., Methods: First-degree relatives of gastric cancer patients underwent endoscopy. Three biopsy specimens from the antrum and 3 from the corpus were evaluated according to the Sydney classification. Serum was taken for the measurement of fasting PGI, PGII, and gastrin 17 by enzyme-linked immunosorbent assay kits., Results: A total of 481 patients were examined (age, 47.8 +/- 6.7 y). With the extension of gastritis, PGII was increased up to 2.5 times (6.6 +/- 2.8 microg/mL in normal mucosa, 9.5 +/- 6.7 microg/mL in antral gastritis, and 16.9 +/- 12.4 microg/mL in corpus-predominant gastritis; P < .01), PGI increased slightly (88.3 +/- 29.4 microg/mL in normal mucosa and 111.2 +/- 71.4 microg/mL in corpus-predominant gastritis), and gastrin 17 was increased substantially in corpus-predominant gastritis (15.3 +/- 19.5 pmol/mL vs 3.8 +/- 5.7 pmol/mL in normal mucosa). By using a cut-off value of 7.5 microg/mL for PGII, any type of gastritis from normal mucosa can be diagnosed with a sensitivity and specificity of 80%. The sensitivity and specificity of the PG I:II ratio (< or =3) and gastrin 17 (>17 pmol/mL) together were 9.4% and 99% for screening corpus-predominant gastritis and 14.8% and 97.8%, respectively, for screening intestinal metaplasia in the corpus., Conclusions: PGII is a suitable marker for screening any gastritis from normal mucosa, but neither PGI, the PG I:II ratio, gastrin 17, nor their combination were able to select those with precancerous conditions and corpus-predominant gastritis among the first-degree relatives of gastric cancer patients.

Background: Furazolidone has been effective against Helicobacter pylori in Iran, with no resistance, but with intolerable side effects in the second week. One-week regimens have not been useful here. We compared the efficacy and side effect profiles of three anti-H. pylori regimens., Methods: Patients with peptic ulcer disease and positive H. pylori infection were randomly allocated into three groups. The patients in group A received omeprazole 20 mg + amoxicillin 1g + metronidazole 500 mg, and bismuth subcitrate 240 mg twice daily each, for two weeks; the patients in group B received the same regimen but metronidazole was replaced by furazolidone 200 mg twice daily; and the patients in group C received regimen B for the first week and regimen A for the second week. H. pylori eradication was verified with 13C-urea breath test at the tenth week., Results: Three hundred and fourteen patients were enrolled; 107, 104, and 103 patients in groups A-C, respectively but 278 patients completed the study. Seven, three, and six patients discontinued their medication in groups A-C, respectively. Fever, dizziness, and weakness were more common in group B than group C (P < 0.05). Vomiting, pruritus, and rash were more common in group C than group A (P < 0.05). Per-protocol eradication rates were 83.1%, 95.2%, and 95.3% in groups A-C, respectively (P = 0.005, groups A and C). Intention to treat eradication rates were 74.5%, 87.0%, and 86.6% in groups A-C, respectively (P = 0.02, groups A and C)., Conclusion: One-week furazolidone followed by one-week metronidazole regimen is as efficient as two-week furazolidone regimen but with fewer side effects. Furazolidone-based regimens are superior to metronidazole-based ones for H. pylori eradication in Iran.

The occurrence of strains resistant to metronidazole is causing failure of the 4-drug regimen for eradication of Helicobacter pylori in the Islamic Republic of Iran. This study compared the in vitro efficacy of furazolidone with metronidazole, clarithromycin, amoxicillin and tetracycline in 70 H. pylori isolates from dyspeptic patients. Of the isolates, 33% were resistant to metronidazole but all were susceptible to furazolidone. Furazolidone could be considered as an appropriate substitute for metronidazole for H. pylori infections.

Aim: To examine the frequency of antibiotic resistance in Iranian Helicobacter pylori (H pylori) strains isolated from two major hospitals in Tehran., Methods: Examination of antibiotic resistance was performed on 120 strains by modified disc diffusion test and PCR-RFLP methods. In addition, in order to identify the possible causes of the therapeutic failure in Iran, we also determined the resistance of these strains to the most commonly used antibiotics (metronidazole, amoxicillin, and tetracycline) by modified disc diffusion test., Results: According to modified disc diffusion test, 1.6% of the studied strains were resistant to amoxicillin, 16.7% to clarithromycin, 57.5% to metronidazole, and there was no resistance to tetracycline. Of the clarithromycin resistant strains, 73.68% had the A2143G mutation in the 23S rRNA gene, 21.05% A2142C, and 5.26% A2142G. None of the sensitive strains were positive for any of the three point mutations. Of the metronidazole resistant strains, deletion in rdxA gene was studied and detected in only 6 (5%) of the antibiogram-based resistant strains. None of the metronidazole sensitive strains possessed rdxA gene deletion., Conclusion: These data show that despite the fact that clarithromycin has not yet been introduced to the Iranian drug market as a generic drug, nearly 20% rate of resistance alerts toward the frequency of macrolide resistance strains, which may be due to the widespread prescription of erythromycin in Iran. rdxA gene inactivation, if present in Iranian H pylori strains, may be due to other genetic defects rather than gene deletion.

Background: Until today, human stomach is the only recognized habitat of Helicobacter pylori. However, recruitment of DNA-based methods has made possible the detection of H. pylori in water and oral cavity, thus suggesting fecal-oral and oral-oral routes for transmission of H. pylori, respectively. In this study, yeast has been proposed as a common vector for transmission of H. pylori. Thus designed primers were recruited to target 16S rDNA and cagA genes in the oral yeasts by PCR., Materials and Methods: Eighteen yeasts were examined microscopically for the presence of bacterial-like bodies. DNAs were extracted from oral yeasts using phenol-chloroform method. Amplification conditions were optimized as 33 cycles and annealing temperatures of 63 degrees C for 16S rDNA and 51 degrees C and 52 degrees C for cagA gene which was targeted in two steps. DNAs of H. pylori and Saccharomyces cerevisiae were used as controls. Polymerase chain reaction (PCR) products of two genes from one yeast and from H. pylori were cloned in pCAP and subsequently subcloned in pSK+ and were sequenced., Results: Bacterial-like bodies were observed in all oral yeasts. The amplified products of 16S rDNA from all oral yeasts were homologous in size with those of H. pylori. Fifteen out of eighteen (83%) yeasts contained cagA gene, homologous to H. pylori. CagA was not amplified from three yeasts and S. cerevisiae. Analysis of the sequenced products of 16S rDNA and cagA from one oral yeast showed 98% homology with those of H. pylori., Conclusions: The presence of H. pylori inside the yeast was indicated by light microscopy and PCR. It appears that yeasts, which are abundant in nature and thrive the mucosal surfaces of human, might serve as reservoirs and vehicles of H. pylori.

Background and Aim: Helicobacter pylori (HP) infection is one of the most prevalent human infections and has been implicated as a predisposing factor in gastric cancer, chronic active gastritis, duodenal ulcer, gastric ulcer and gastric lymphoma. Reinfection after successful eradication is quite uncommon in adults. In the only study carried out in Iran, a reinfection rate of 19.1% after 1 year has been reported. We studied the rate of reinfection 3 years after successful HP eradication., Methods: All patients who had undergone HP eradication 3 years before the study and had successful eradication verified by a negative (14)C urea breath test (UBT) 1 year after eradication were invited to complete a questionnaire and undergo another UBT. In addition, spouses and the offspring of those testing positive were offered an UBT., Results: Ninety-eight patients were enrolled (49% male). Mean age was 44 +/- 13 years (range: 18-75 years). Twenty patients (20.4%) had a positive UBT. Epigastric burning (25%vs 69%) and pyrosis (50%vs 67%) were seen less commonly in those who were HP free at 3 years compared to those who tested positive for HP., Conclusions: According to our data, in our region the HP reinfection rate is 20.4% 3 years after successful eradication.

Background: Resistance to metronidazole is one of the most common reasons for Helicobacter pylori treatment failure with classic triple therapy. In contrast, the clarithromycin-based regimen is not cost-effective for developing countries. Furazolidone is a very good substitute for metronidazole and clarithromycin, but its many side-effects limit widespread use. The aim of the present study was to assess the efficacy of two different doses of furazolidone in combination with amoxycillin and omeprazole., Methods: A total of 123 patients with duodenal ulcer were randomized and received the following medications for two weeks. Group A: furazolidone 2 x 200 mg + amoxycillin 2 x 1 g + omeprazole 2 x 20 mg/day. Group B: furazolidone 2 x 50 mg + amoxycillin 2 x 1 g + omeprazole 2 x 20 mg/day. Control endoscopy was performed after 6 weeks and two biopsy specimens from the antrum and two from the corpus were taken for a urease test and histology. Eradication was concluded if all tests were negative for H. pylori., Results: In total, 110 patients completed the study. Four patients in group A did not tolerate the regimen on day 8 of therapy and were excluded from the study. Serious complications such as fever, and fatigue and dizziness, which occurred in the beginning of the second week of treatment (days 8-10), were more common in group A than in group B (19%, 15.9% and 14.3%, respectively, in group A vs 0% in group B). The eradication rate by per protocol analysis was significantly higher in group A than in group B (88.9%vs 67.9%, respectively, P = 0.008). However, this difference was low and not statistically significant by intention-to-treat analysis (76.2% in group A and 62.3% in group B, P = 0.09)., Conclusion: The regimen with a non-reduced dose of furazolidone in combination with amoxycillin and omeprazole was effective when the patients tolerated the drugs and completed the study., (Copyright 2003 Blackwell Publishing Asia Pty Ltd)

Helicobacter pylori infects the majority of the population in the developing countries. However, the rate of gastrointestinal complications such as peptic ulcers and gastric malignancies has no parallel with the infection. In order to determine whether cytotoxin (vacA) and its allelic polymorphism can serve as screening markers for such a population, H. pylori strains were isolated from one hundred and thirty two dyspeptic patients. H. pylori genomic DNA was extracted and underwent PCR-amplification for the cytotoxin alleles. Genotyping of the signal sequence region of the vacA gene identified 68% (70 out of 103) of patients with non ulcer dyspepsia (NUD) and 79% (23 out of 29) of the patients with peptic ulcer disease (PUD) possessing the s1 genotype. S1 strains were significantly more prevalent among patients with PUD as compared to the NUD (p < 0.05). In regard to the middle region, 55% of the patient isolates belonged to the m2 genotype with no correlation to disease. The s1m2 genotype was the most prevalent among all patients and significantly correlated with the PUD group (p < 0.05).

Background: Prevalence of gallstone disease is different depending on the geographic region involved. Few studies, in Asia but not from Iran, about the frequency of gallstone disease have been published. The aim of this study is to examine the prevalence of gallstone disease in Iran., Methods: Four hundred and seventy-seven nomads from southern Iran, 513 industrial laborers older than 34 years, and 421 laborers from a pharmaceutical company above 30 years of age, and 471 elderly persons from three nursing homes near Tehran underwent abdominal sonography., Results: There were 1373 men and 509 women. Eighty-nine subjects had gallstone disease and 10.1% of them were cholecystectomized. While the prevalence in the men and women in the age group 31-40 years was very low (0.3% in men and 1.8% in women), it increases sharply in men older than 60 years and women older than 50 years to more than 10-fold (12.5 and 24.6% in male and female with an age 71-80 years, respectively)., Conclusion: In Iran, gallstone disease is very uncommon in middle-aged people, but increases sharply in older people. However, this does not reach the high prevalence seen in Western countries. The intake of a high fiber-containing diet, a low number of overweight people, smoking habit and hyperlipidemia are probably the cause for this low prevalence.

Background and Aim: We sought to compare the efficacy and tolerability of an omeprazole/clarithromycin/bismuth/tetracycline-based quadruple therapy to that of a ranitidine/metronidazole/bismuth/tetracycline-based quadruple therapy of 2 or 3 weeks duration in a population with a high prevalence of metronidazole-resistant Helicobacter pylori and low triple therapy eradication rates., Methods: Two hundred and twenty-one patients who presented endoscopically proven duodenal ulcers and a positive rapid urease test were randomized to receive either: (i) omeprazole 20 mg b.i.d., clarithromycin 250 mg b.i.d., bismuth subcitrate 240 mg b.i.d. and tetracycline 500 mg b.i.d (OCBT) for 2 weeks; (ii) ranitidine 300 mg b.i.d., metronidazole 500 mg b.i.d, bismuth subcitrate 240 mg b.i.d. and tetracycline 500 mg b.i.d. (RMBT2) for 2 weeks; or (iii) ranitidine 300 mg b.i.d., metronidazole 500 mg b.i.d, bismuth subcitrate 240 mg b.i.d. and tetracycline 500 mg b.i.d. (RMBT3) for 3 weeks. Patients were interviewed 2 weeks after the completion of therapy to review compliance and side-effects. Eradication of H. pylori was assessed 8 weeks after the completion of therapy with the use of a 14C-urea breath test., Results: The per-protocol eradication rate was significantly higher with OCBT (88%) than RMBT2 (73%) or RMBT3 (71%) (P<0.05). The intent-to-treat eradication rate was numerically higher with OCBT (80%) than RMBT2 (68%) or RMBT3 (68%), although this difference did not reach statistical significance (P=0.09). Per-protocol or intent-to-treat eradication rates were similar with RMBT2 and RMBT3. There were significantly greater side-effects with the RMBT2 regimen., Conclusions: The omeprazole/clarithromycin/bismuth/tetracycline-based quadruple therapy provides higher H. pylori eradication rates than the ranitidine/metronidazole/bismuth/tetracycline-based quadruple therapy when administered per protocol. The prolongation of the latter regimen from 2 to 3 weeks did not increase eradication rates.

Background/aim: In developing countries the standard quadruple therapy containing metronidazole results in suboptimal eradication rates of Helicobacter pylori (<75%). In a retrospective study, we undertook to evaluate efficacy and tolerability of a furazolidone-based regimen (omeprazole, furazolidone, bismuth, and tetracycline) in patients who had previously failed the standard metronidazole-based regimen (omeprazole, metronidazole, bismuth, and amoxicillin)., Methods: The records of H. pylori infected patients who were referred to outpatient clinic (from March 1999 to August 1999) and who underwent previous eradication regimens were studied. A total of 320 cases were noted to have received a metronidazole-based quadruple regimen. From these 320 patients, 80 were noted to have failed this regimen based on a urea breath test. These 80 patients were enrolled in the study and given the furazolidone-based regimen. Side effects were assessed at follow-up visits. At least 2 months after the end of each therapy regimen, a (14)C-urea test was performed in each subject to document the cure of the patients., Results: A total of 80 patients (39 males and 41 females) with a mean age of 43.8 +/- (SD) 13.3 years were studied. The H. pylori eradication rate was 90% with the furazolidone-based regimen. The side effects of this regimen were minor., Conclusions: A furazolidone-based regimen is effective in patients who do not achieve cure of H. pylori infection with the metronidazole-based quadruple therapy. In areas where the metronidazole resistance is high, initial therapy with a furazolidone-based regimen is recommended., (Copyright 2002 S. Karger AG, Basel)

In almost all eradication regimens, which contain antibiotics and bismuth derivatives, the administration of acid suppressing drugs for 4-6 weeks is recommended for healing of duodenal ulcer. The aim of this multicenter double blind study is to elucidate the effect of two classic antibiotics tetracycline (CAS 60-54-8) and metronidazole (CAS 443-48-1) alone or combined with ranitidine (CAS 66357-35-5) on the healing of duodenal ulcer and eradication of Helicobacter Pylori. Patients with duodenal ulcer were randomized to two treatment groups: group A received either ranitidine 4 x 150 mg or tetracycline 4 x 500 mg or metronidazole 3 x 250 mg for 2 weeks. Group B received 4 x placebo + tetracycline and metronidazole as in group A for 2 weeks. A final endoscopy was performed after 8 weeks. Four biopsy specimens were obtained from the antrum (two) and corpus (two) for both urease test and hematoxylin stain for detection of H. pylori. Out of 201 patients entering the study 156 completed the study (78 in A and 78 in B). The healing rate of duodenal ulcer was 98.7% in group A and 97.5 in group B. The eradication rate was only 33.3% in group B but 64% in group A (p < 0.001), when additionally ranitidine was given. The present study shows that treatment with the two antibiotics tetracycline and metronidazole alone results in a very low H. pylori eradication, but almost complete healing of duodenal ulcer after 8 weeks. Prolonged administration of antisecretory drugs in eradication regimens containing two antibiotics is not necessary for duodenal ulcer healing. However, the addition of H2-receptor antagonists or proton pump inhibitors to antibiotics increases the eradication rate.

Objective: To determine the prevalence of peptic ulcer disease, irritable bowel syndrome (IBS) and chronic constipation in two Iranian populations (pastoral nomads and industrial labourers) with different life styles, and to evaluate the risk factors associated with these diseases., Subjects: A total of 455 randomly selected pastoral nomads and 492 industrial labourers (all male) aged between 35-55 years., Methods: Demographic and social data were obtained by interviews. An upper gastrointestinal tract endoscopy was performed and biopsy specimens were taken from subjects complaining of abdominal symptoms and randomly selected asymptomatic subjects. A urease test was performed on antral specimens. Serum pepsinogen I concentrations and Helicobacter pylori antibody titres were measured by radioimmunoassay and immunoglobulin (Ig) G enzyme-linked immunosorbent assay tests, respectively., Results: Serum pepsinogen I concentrations were similar in both nomads and industrial labourers, and the percentage with positive antibody titres for H. pylori was high in both populations (86.3 and 91% in nomads and industrial labourers, respectively). Industrial labourers were twice as likely to have duodenal ulcer (P < 0.05) than nomads. The prevalence of duodenal ulcer disease and gastric ulcer was 4.6 and 0.6% in nomads and 10.3 and 0.4% in industrial labourers, respectively. The prevalence of IBS was similar in nomads (3.1%) and industrial labourers (3.6%). Fewer nomads (1.4%) than industrial labourers (3.3%) had chronic constipation. Logistic regression analysis showed that being an industrial labourer, or smoker and having undergone previous non-gastric surgery were risk factors for duodenal ulcer disease. When the variable 'urease test' was included in the logistic regression analysis, smoking, a positive urease test and the quantity of fruit eaten per week were associated risk factors. The risk factors associated with IBS were the use of analgesics and back pain. The only risk factor associated with chronic constipation was being an industrial labourer., Conclusions: Industrial labourers were twice as likely to have duodenal ulcer disease as nomads. The prevalence of IBS and chronic constipation in the two male Iranian populations was lower than that found in western countries. Duodenal ulcer disease was associated with H. pylori colonization but not with a positive serum antibody titre for H. pylori. H. pylori colonization of the antral mucosa and smoking are causative factors for duodenal ulcer disease and fruit intake is possibly an associated factor.

The levels of total pepsin activity and pepsinogen I in sera were first studied in 10 healthy volunteers undergoing stimulation of gastric acid secretion at random on 4 different days with a) a maximum dose (6 micrograms/kg) of pentagastrin, b) ranitidine injection 5 minutes before maximal pentagastrin stimulation, c) ranitidine injection 1 hr before maximal pentagastrin stimulation, or d) sham feeding. In a further 10 healthy volunteers the levels of total pepsin activity and pepsinogen I were studied over 5 days by short-term oral intake of ranitidine. The total pepsin activity and pepsinogen I increased significantly in the sera after maximum-dose pentagastrin, but not after sham feeding. The increase could be completely prevented by ranitidine given only 1 hour before pentagastrin stimulation. The total pepsin activity and pepsinogen I decreased significantly after brief oral intake of ranitidine. It can be concluded that the measurement of total pepsin activity and pepsinogen I in the sera could serve as a rough parameter for testing the effectiveness of potential agents inhibiting gastric secretion.

A clinical trial involving 100 duodenal ulcer patients was performed at the Shiraz Medical School in Iran, in which the known risk factors that influence the healing of duodenal ulcers in West Germany were examined. The patients were randomly allocated to groups receiving 2 x 400 mg cimetidine daily for 10 days (group I) or 28 days (group II). In addition, antacid was taken if pain occurred. Probable prognostic risk factors were noted, such as: age, sex, duration of ulcer history, duration of the present ulcer relapse, smoking habit, nocturnal pain, radiation of pain to the back, history of ulcer bleeding and use of analgesics. The number of ulcers, ulcer size, ulcer depth, bulbar deformity and narrowing were determined endoscopically. Follow-up examinations were performed in 89 patients 4 weeks after the start of treatment. The ulcers were healed in 20 out of 43 patients in group I (46%), and in 29 out of 46 in group II (63%) (p = 0.11). Statistical analyses were performed in both group combined to investigate unfavorable factors for healing. Following univariate analysis the following factors were prognostically unfavorable: bulb deformity (p = 0.003), radiation of pain to the back before treatment (p = 0.045), number of cigarettes smoked per day (p = 0.046). The patients with non-healed ulcers had more days with pain during treatment (p = 0.045). Using logistic regression analysis, the following prognostic factors were significant: number of cigarettes smoked per day (p = 0.03), radiation of pain to the back (p = 0.036), and bulb deformity (p = 0.048).(ABSTRACT TRUNCATED AT 250 WORDS)

From a group of 424 patients with histologically verified fatty liver 92 patients without diabetes mellitus and alcohol abuse were subjected to follow-up examination for 3 1/2 years. 56 patients underwent second liver biopsy at this time; 20 of these patients had shown marked fatty liver at the initial liver biopsy examination. These 20 patients with marked fatty liver and 25 further patients with moderarte fatty liver could be followed up 5 and 7 1/2 years later; the clinical examination, the various liver function tests, liver scan and blind liver biopsy did not show any evidence of progression of fatty liver towards chronic inflammatory liver disorders or precirrhotic states. This clinical study therefore suggests the harmlessness of non-alcoholic fatty liver.

The long term effect of 400 mg cimetidine ingested at various times on ulcer recurrence and drug compliance was investigated in 66 patients with severe course of duodenal ulcer, now healed. Patients were randomised in 3 treatment groups: group A (n = 29) received 400 mg cimetidine in the evening, group B (n = 23) 200 mg both morning and evening, group C (n = 14) no treatment. Follow up examinations were at 3 month intervals. Ulcer recurrence was observed in 10 out of 14 patients in group C and in 12 out of 52 patients of groups A and B within the first 6 months. Due to the highly significant difference between the treated and untreated groups (P less than 0.001) the control group was discontinued. The recurrence rate after 12 months was identical in groups A and B (51 and 52%). Comparison of patients with and without recurrences showed no differences as regards length of history, maximal acid secretion, cimetidine compliance or endoscopic findings such as duodenitis, circular constriction of the bulbus or antral erosions. However, it was noticeable that smokers with 63% recurrent ulceration had a worse prognosis than the non-smokers with 37% (P = 0.06).

A selected group of 21 patients having received antacids (neutralizing capacity less than 50 meq HCl/d) as treatment for duodenal ulcers showed no improvement of the disease as demonstrated by endoscopic control after 8-16 weeks. Subsequent treatment of this group with 1 g Cimetidin/d for periods of 4-8 weeks was successful as far as healing of the ulcers is concerned in 85% of the cases, however symptoms of duodenitis persisted. In a control group of 39 patients which did not improve after 8 weeks of treatment with antacids the same therapy was continued for another 8 weeks; during this second period ulcers disappeared in 12 patients = 30% of the group. Improvement of symptoms resulted on the average after 6 days of therapy with cimetidine. One third of the patients treated with cimetidine relapsed with ulcers after approximately 4 months as demonstrated by endoscopy. Patients with duodenal ulcers resistant to therapy with antacids do represent a selected group suited to test the potency of new therapeutic methods as for instance treatment with cimetidine.

The various complaints after gastroscopy and the acceptability of the procedures are verified by a questionnaire in 300 consecutively examined patients with or without gastric lesions. The extent of psychic lability, neurosis and extraversion was determined by the Maudsley Personality Inventory test of Eysenck. The time necessary for the passage of the instrument (swallowing time) and the time taken by gastroscopy were registered on each patient. More than half of the patients complained of sore throat lasting more than 1 day. Less than a quarter had abdominal dyspepsia. The intensity of the sore throat was correlated with the swallowing time but not with the extent of neurosis or gastroscopy time. 98% of the patients consented to a control examination. The necessity of a gastroscope with less diameter and a non mucosal damaging top is stressed.

The morphological changes of gastric mucosa taken from different areas has been studied in patients of approximately the same age with achlorhydria, extreme hypochlorhydria and normochlorhydria. The serum gastrin level and parietal cell antibodies were determined in the achlorhydric parietal cell antibodies were determined in the achlorhydric patients. In the latter the diffuse gastritis was localized in the corpus-fundic area, while the changes in the antral region were few and occurred mostly in the superficial zone. In normochlorhydric patients however, the diffuse gastritis was localized in the antral region, with only few changes at the corpus-fundic area. In patients with extreme hypochlorhydira either the fundic or the antral region was involved. Besides the diffuse gastritis intestinal metaplasia, pseudopyloric metaplasia, and atrophy of mucosa were also observed, although much less commonly. The increase of gastrin level could not be related to a definite morphological pattern in the gastric mucosa. It can be assumed that each of the two types of gastritis has a different natural history; the antral site of gastrititis cannot be transformed into the fundic site, nor can the fundic site be transformed into the antral site.

Four biopsy specimens of antral and body mucosa were taken from the greater and lesser curvature of the stomach in 557 Germans and 46 Turks with no gastric or duodenal lesions. The age-adjusted gastritis score in each area was related to various habits and clinical diagnoses. In contrast to the Germans the Turks had advanced antral gastritis at an early age which did not progress with age. Patients of low social class were more prone to antral gastritis than academics and civil servants. Hypertension was associated with a lower incidence of antral gastritis. Patients who had had a cholecystectomy had advanced gastritis in antral and body mucosa as compared with those with gallstones but intact gallbladders. The incidence of fundic gastritis was higher in patients with degenerative joint disease than in the controls. It is concluded that alcohol, nicotine, drug abuse and various diseases do not play an important role in the frequency of occurrence of gastritis.

The activities of alkaline phosphatase (AP), gamma-glutamyl-transpeptidase and leucine aminopeptidase as well as the total bile salt concentration (Tbs) were measured in bile specimens collected spontaneously at 7 and 11 a.m. and 4 and 9 p.m. from the 3rd-9th postoperative day of 16 patients with T-tube insertion. The general trend for all cholestatic enzymes to increase or decrease was in some way related to the total bile salt concentration. The best correlation was found between AP and Tbs (r = 0.48). It is suggested that the enterohepatic circulation of bile salts may lead to the delivery of membrane-bound cholestatic enzymes into the bile canaliculi without damage to the hepatocyte.

The lithogenicity of bile samples taken over 14 hrs from 7 a.m. to 9 p.m. on two consecutive days at 4-5 hrs intervals has been measured in 7 freshly colecystectomized patients on the 7th to 9th postoperative days. The values have also been estimated additionally in 4 patients 1 and 2 hrs after meal intake. It was found that the lithogenicindex is higher at 16 and 21 hrs than at 7 and 11 hrs. The lithogenicity began to increase 2 hrs after lunch. The observed difference between our results and those of other authors could be due either to the changed enterohepatic circulation before the begin of our study or to the different types of populations studied.

Corresponding and differing parameters in normal and inflamed duodenal mucosa are compared in a morphometric, histologic study. Results of this study show that the density of cellular infiltration into the lamina propria is decisive for the diagnosis of duodenitis, in particular the composition of plasma cells and lymphocytes. This diagnosis is supported by dilatation of Brunner's glands, cellular infiltration of the muscularis mucosae, and by gastric metaplasia of the duodenal epithelium. The length and width of the villi and crypts, the number of goblet cells and Paneth cells, the mitotic rate, and hemorrhage and hyperemia are inappropriate differential diagnosticc criteria.