Transient receptor potential ion channels V4 and A1 contribute to pancreatitis pain in mice.

The mechanisms of pancreatic pain, a cardinal symptom of pancreatitis, are unknown. Proinflammatory agents that activate transient receptor potential (TRP) channels in nociceptive neurons can cause neurogenic inflammation and pain. We report a major role for TRPV4, which detects osmotic pressure and arachidonic acid metabolites, and TRPA1, which responds to 4-hydroxynonenal and cyclopentenone prostaglandins, in pancreatic inflammation and pain in mice. Immunoreactive TRPV4 and TRPA1 were detected in pancreatic nerve fibers and in dorsal root ganglia neurons innervating the pancreas, which were identified by retrograde tracing. Agonists of TRPV4 and TRPA1 increased intracellular Ca(2+) concentration ([Ca(2+)](i)) in these neurons in culture, and neurons also responded to the TRPV1 agonist capsaicin and are thus nociceptors. Intraductal injection of TRPV4 and TRPA1 agonists increased c-Fos expression in spinal neurons, indicative of nociceptor activation, and intraductal TRPA1 agonists also caused pancreatic inflammation. The effects of TRPV4 and TRPA1 agonists on [Ca(2+)](i), pain and inflammation were markedly diminished or abolished in trpv4 and trpa1 knockout mice. The secretagogue cerulein induced pancreatitis, c-Fos expression in spinal neurons, and pain behavior in wild-type mice. Deletion of trpv4 or trpa1 suppressed c-Fos expression and pain behavior, and deletion of trpa1 attenuated pancreatitis. Thus TRPV4 and TRPA1 contribute to pancreatic pain, and TRPA1 also mediates pancreatic inflammation. Our results provide new information about the contributions of TRPV4 and TRPA1 to inflammatory pain and suggest that channel antagonists are an effective therapy for pancreatitis, when multiple proinflammatory agents are generated that can activate and sensitize these channels.

Mechanisms of protease-activated receptor 2-evoked hyperexcitability of nociceptive neurons innervating the mouse colon

Agonists of protease-activated receptor 2 (PAR(2)) evoke hyperexcitability of dorsal root ganglia (DRG) neurons by unknown mechanisms. We examined the cellular mechanisms underlying PAR(2)-evoked hyperexcitability of mouse colonic DRG neurons to determine their potential role in pain syndromes such as visceral hyperalgesia. Colonic DRG neurons were identified by injecting Fast Blue and DiI retrograde tracers into the mouse colon. Using immunofluorescence, we found that DiI-labelled neurons contained PAR(2) immunoreactivity, confirming the presence of receptors on colonic neurons. Whole-cell current-clamp recordings of acutely dissociated neurons demonstrated that PAR(2) activation with a brief application (3 min) of PAR(2) agonists, SLIGRL-NH(2) and trypsin, evoked sustained depolarizations (up to 60 min) which were associated with increased input resistance and a marked reduction in rheobase (50% at 30 min). In voltage clamp, SLIGRL-NH(2) markedly suppressed delayed rectifier I(K) currents (55% at 10 min), but had no effect on the transient I(A) current or TTX-resistant Na(+) currents. In whole-cell current-clamp recordings, the sustained excitability evoked by PAR(2) activation was blocked by the PKC inhibitor, calphostin, and the ERK(1/2) inhibitor PD98059. Studies of ERK(1/2) phosphorylation using confocal microscopy demonstrated that SLIGRL-NH(2) increased levels of immunoreactive pERK(1/2) in DRG neurons, particularly in proximity to the plasma membrane. Thus, activation of PAR(2) receptors on colonic nociceptive neurons causes sustained hyperexcitability that is related, at least in part, to suppression of delayed rectifier I(K) currents. Both PKC and ERK(1/2) mediate the PAR(2)-induced hyperexcitability. These studies describe a novel mechanism of sensitization of colonic nociceptive neurons that may be implicated in conditions of visceral hyperalgesia such as irritable bowel syndrome.

Signaling via NF-kappaB in the nervous system

Nuclear factor kappa B (NF-kappaB) is an inducible transcription factor present in neurons and glia. Recent genetic models identified a role for NF-kappaB in neuroprotection against various neurotoxins. Furthermore, genetic evidence for a role in learning and memory is now emerging. This review highlights our current understanding of neuronal NF-kappaB in response to synaptic transmission and summarizes potential physiological functions of NF-kappaB in the nervous system. This article contains a listing of NF-kappaB activators and inhibitors in the nervous system, furthermore specific target genes are discussed. Synaptic NF-kappaB activated by glutamate and Ca2+ will be presented in the context of retrograde signaling. A controversial role of NF-kappaB in neurodegenerative diseases will be discussed. A model is proposed explaining this paradox as deregulated physiological NF-kappaB activity, where novel results are integrated, showing that p65 could be turned from an activator to a repressor of anti-apoptotic genes.

Transcription factor NF-kappaB is transported to the nucleus via cytoplasmic dynein/dynactin motor complex in hippocampal neurons

Background Long-term changes in synaptic plasticity require gene transcription, indicating that signals generated at the synapse must be transported to the nucleus. Synaptic activation of hippocampal neurons is known to trigger retrograde transport of transcription factor NF-κB. Transcription factors of the NF-κB family are widely expressed in the nervous system and regulate expression of several genes involved in neuroplasticity, cell survival, learning and memory. Principal Findings In this study, we examine the role of the dynein/dynactin motor complex in the cellular mechanism targeting and transporting activated NF-κB to the nucleus in response to synaptic stimulation. We demonstrate that overexpression of dynamitin, which is known to dissociate dynein from microtubules, and treatment with microtubule-disrupting drugs inhibits nuclear accumulation of NF-κB p65 and reduces NF-κB-dependent transcription activity. In this line, we show that p65 is associated with components of the dynein/dynactin complex in vivo and in vitro and that the nuclear localization sequence (NLS) within NF-κB p65 is essential for this binding. Conclusion This study shows the molecular mechanism for the retrograde transport of activated NF-κB from distant synaptic sites towards the nucleus.

Evaluation of moisture sources for the Central European summer flood of May/June 2013 based on regional climate model simulations

Heavy precipitation affected Central Europe in May/June 2013, triggering damaging floods both on the Danube and the Elbe rivers. Based on a modelling approach with COSMO-CLM, moisture fluxes, backward trajectories, cyclone tracks and precipitation fields are evaluated for the relevant time period 30 May–2 June 2013. We identify potential moisture sources and quantify their contribution to the flood event focusing on the Danube basin through sensitivity experiments: Control simulations are performed with undisturbed ERA-Interim boundary conditions, while multiple sensitivity experiments are driven with modified evaporation characteristics over selected marine and land areas. Two relevant cyclones are identified both in reanalysis and in our simulations, which moved counter-clockwise in a retrograde path from Southeastern Europe over Eastern Europe towards the northern slopes of the Alps. The control simulations represent the synoptic evolution of the event reasonably well. The evolution of the precipitation event in the control simulations shows some differences in terms of its spatial and temporal characteristics compared to observations. The main precipitation event can be separated into two phases concerning the moisture sources. Our modelling results provide evidence that the two main sources contributing to the event were the continental evapotranspiration (moisture recycling; both phases) and the North Atlantic Ocean (first phase only). The Mediterranean Sea played only a minor role as a moisture source. This study confirms the importance of continental moisture recycling for heavy precipitation events over Central Europe during the summer half year.

Contextual, but not auditory, fear conditioning is disrupted by neurotoxic selective lesion of the basal nucleus of amygdala in rats

The basolateral amygdala complex (BLA) is involved in acquisition of contextual and auditory fear conditioning. However, the BLA is not a single structure but comprises a group of nuclei, including the lateral (LA), basal (BA) and accessory basal (AB) nuclei. While it is consensual that the LA is critical for auditory fear conditioning, there is controversy on the participation of the BA in fear conditioning. Hodological and neurophysiological findings suggest that each of these nuclei processes distinct information in parallel; the BA would deal with polymodal or contextual representations, and the LA would process unimodal or elemental representations. Thus, it seems plausible to hypothesize that the BA is required for contextual, but not auditory, fear conditioning. This hypothesis was evaluated in Wistar rats submitted to multiple-site ibotenate-induced damage restricted to the BA and then exposed to a concurrent contextual and auditory fear conditioning training followed by separated contextual and auditory conditioning testing. Differing from electrolytic lesion and lidocaine inactivation, this surgical approach does not disturb fibers of passage originating in other brain areas, restricting damage to the aimed nucleus. Relative to the sham-operated controls, rats with selective damage to the BA exhibited disruption of performance in the contextual, but not the auditory, component of the task. Thus, while the BA seems required for contextual fear conditioning, it is not critical for both an auditory-US association, nor for the expression of the freezing response. (C) 2009 Elsevier Inc. All rights reserved.

Chemical identity and connections of medial preoptic area neurons expressing melanin-concentrating hormone during lactation

Lactation is an energy-demanding process characterized by massive food and water consumption, cessation of the reproductive cycle and induction of maternal behavior. During lactation, melanin-concentrating hormone (MCH) mRNA and peptide expression are increased in the medial preoptic area (MPO) and in the anterior paraventricular nucleus of the hypothalamus. Here we show that MCH neurons in the MPO coexpress the GABA synthesizing enzyme GAD-67 mRNA. We also show that MCH neurons in the MPO of female rats are innervated by neuropeptides that control energy homeostasis including agouti-related protein (AgRP), alpha-melanocyte stimulating hormone (alpha MSH) and cocaine- and amphetamine-regulated transcript (CART). Most of these inputs originate from the arcuate nucleus neurons. Additionally, using injections of retrograde tracers we found that CART neurons in the ventral premammillary nucleus also innervate the MPO. We then assessed the projections of the female MPO using injections of anterograde tracers. The MPO densely innervates hypothalamic nuclei related to reproductive control including the anteroventral periventricular nucleus, the ventrolateral subdivision of the ventromedial nucleus (VMHvl) and the ventral premammillary nucleus (PMV). We found that the density of MCH-ir fibers is increased in the VMHvl and PMV during lactation. Our findings suggest that the expression of MCH in the MPO may be induced by changing levels of neuropeptides involved in metabolic control. These MCH/GABA neurons may, in turn, participate in the suppression of cyclic reproductive function and/or sexual behavior during lactation through projections to reproductive control sites. (C) 2009 Elsevier B.V. All rights reserved.

Melanin-concentrating hormone projections to areas involved in somatomotor responses

The lateral hypothalamic area (LHA) participates in the integration of sensory information and somatomotor responses associated with hunger and thirst. Although the LHA is neurochemically heterogeneous, a particularly high number of cells express melanin-concentrating hormone (MCH), which has been reported to play a role in energy homeostasis. Treatment with MCH increases food intake, and MCH mRNA is overexpressed in leptin-deficient (ob/ob) mice. Mice lacking both MCH and leptin present reduced body fat, mainly due to increased resting energy expenditure and locomotor activity. Dense MCH innervation of the cerebral motor cortex (MCx) and the pedunculopontine tegmental nucleus (PPT), both related to motor function, has been reported. Therefore, we postulated that a specific group of MCH neurons project to these areas. To investigate our hypothesis, we injected retrograde tracers into the MCx and the PPT of rats, combined with immunohistochemistry. We found that 25% of the LHA neurons projecting to the PPT were immunoreactive for MCH, and that 75% of the LHA neurons projecting to the MCx also contained MCH. Few MCH neurons were found to send collaterals to both areas. We also found that 15% of the incerto-hypothalamic neurons projecting to the PPT expressed MCH immunoreactivity. Those neurons preferentially innervated the rostral PPT. In addition, we observed that the MCH neurons express glutamic acid decarboxylase mRNA, a gamma-aminobutyric acid (GABA) synthesizing enzyme. We postulate that MCH/GABA neurons are involved in the inhibitory modulation of the innervated areas, decreasing motor activity in states of negative energy balance. (C) 2007 Published by Elsevier B.V.

Prefrontal afferents to the dorsal raphe nucleus in the rat

The prefrontal cortex (PFC) receives strong inputs from monoaminergic cell groups in the brainstem and also sends projections to these nuclei. Recent evidence suggests that the PFC exerts a powerful top-down control over the dorsal raphe nucleus (DR) and that it may be involved in the actions of pharmaceutical drugs and drugs of abuse. In the light of these findings, the precise origin of prefrontal inputs to DR was presently investigated by using the cholera toxin subunit b (CTb) as retrograde tracer. All the injections placed in DR produced retrograde labeling in the medial, orbital, and lateral divisions of the PFC as well as in the medial part of the frontal polar cortex. The labeling was primarily located in layer V. Remarkably, labeling in the medial PFC was denser in its ventral part (infralimbic and ventral prelimbic cortices) than in its dorsal part (dorsal prelimbic, anterior cingulate and medial precentral cortices). After injections in the rostral or caudal DR, the largest number of labeled neurons was observed in the medial PFC, whereas after injections in the mid-rostrocaudal DR, the labeled neurons were more homogeneously distributed in the three main PFC divisions. A cluster of labeled neurons also was observed around the apex of the rostral pole of the accumbens, especially after rostral and mid-rostrocaudal DR injections. Overall, these results confirm the existence of robust preftontal projections to DR, mainly derived from the ventral part of the medial PFC, and underscore a substantial contribution of the frontal polar cortex. (C) 2008 Elsevier Inc. All rights reserved.

Tectonothermal evolution and exhumation history of the Paleozoic Proto-Andean Gondwana margin crust: The Famatinian Belt in NW Argentina

We studied the P-T-t evolution of a mid-crustal igneous-metamorphic segment of the Famatinian Belt in the eastern sector of the Sierra de Velasco during its exhumation to the upper crust. Thermobarometric and geochronological methods combined with field observations permit us to distinguish three tectonic levels. The deepest Level I is represented by metasedimentary xenoliths and characterized by prograde isobaric heating at 20-25 km depth. Early/Middle Ordovician granites that contain xenoliths of Level I intruded in the shallower Level II. The latter is characterized by migmatization coeval with granitic intrusions and a retrograde isobaric cooling P-T path at 14-18 km depth. Level II was exhumed to the shallowest supracrustal Level III, where it was intruded by cordierite-bearing granites during the Middle/Late Ordovician and its host-rock was locally affected by high temperature-low pressure HT/LP metamorphism at 8-10 km depth. Level III was eventually intruded by Early Carboniferous granites after long-term slow exhumation to 6-7 km depth. Early/Middle Ordovician exhumation of Level II to Level III (Exhumation Period I,0.25-0.78 mm/yr) was faster than exhumation of Level III from the Middle/Late Ordovician to the Lower Carboniferous (Exhumation Period II, 0.01-0.09 mm/yr). Slow exhumation rates and the lack of regional evidence of tectonic exhumation suggest that erosion was the main exhumation mechanism of the Famatinian Belt. Widespread slow exhumation associated with crustal thickening under a HT regime suggests that the Famatinian Belt represents the middle crust of an ancient Altiplano-Puna-like orogen. This thermally weakened over-thickened Famatinian crust was slowly exhumed mainly by erosion during similar to 180 Myr. (C) 2010 International Association for Gondwana Research. Published by Elsevier B.V. All rights reserved.

Metamorphic P-T evolution of granulites in the central Ribeira Fold Belt, SE Brazil

Pseudosections, geothermobarometric estimates and careful petrographic observations of gneissic migmatites and granulites from Neoproterozoic central Ribeira Fold Belt (SE Brazil) were performed in order to quantify the metamorphic P-T conditions during prograde and retrograde evolution of the Brasiliano Orogeny. Results establish a prograde metamorphic trajectory from amphibolite facies conditions to metamorphic peak (T = 850 +/- 50 A degrees C; P = 8 +/- 1 kbar) that promoted widespread dehydrationmelting of 30 to 40% of the gneisses and high-grade granitization. After the metamorphic peak, migmatites evolved with cooling and decompression to T a parts per thousand 500 A degrees C and P a parts per thousand 5 kbar coupled with aH2O increase, replacing the high-grade paragenesis plagioclase-quartz-K-feldspar-garnet by quartz-biotite-sillimanite-(muscovite). Cordierite absence, microtextural observations and P-T results constrain the migmatite metamorphic evolution in the pseudosections as a clockwise P-T path with retrograde cooling and decompression. High-temperature conditions further dehydrated the lower crust with biotite and amphibole-dehydration melting and granulite formation coupled with 10% melt generation. Granulites can thus be envisaged as middle to lower crust dehydrated restites. Granulites were slowly (nearly isobarically) cooled, followed by late exhumation/retrograde rapid decompression and cooling, reflecting a two step P-T path. This retrograde evolution, coupled with water influx, chemically reequilibrated the rocks from granulite to amphibolite/greenschist facies, promoting the replacement of the plagioclase-quartz-garnet-hypersthene peak assemblage by quartz-biotite- K-feldspar symplectites.

Unraveling an antique subduction process from metamorphic basement around Medellin city, Central Cordillera of Colombian Andes

In the surroundings of Caldas and El Retiro cities (Colombia) metamorphic rocks derived from basic and pelitic protoliths comprise the Caldas amphibole schist and the Ancon schist respectively. Subordinated metamorphosed granite bodies (La Miel gneiss) are associated to these units, and The El Retiro amphibolites, migmatites and granulites crops out eastwards of these units, separated by shear zones. The Caldas amphibole schist and the Ancon schist protoliths could have been formed in a distal marine reduced environment and amalgamated to the South American continent in an apparent Triassic subduction event. The El Retiro rocks are akin to a continental basement and possible include impure metasediments of continental margin, whose metamorphism originated granulite facies rocks and migmatites as a result of the anatexis of quartz-feldspathic rocks. The metamorphism was accompanied by intense deformation, which has juxtaposed both migmatites and granulite blocks. Afterward, heat and fluid circulation associated with the emplacement of minor igneous intrusions resulted in intense fluid-rock interaction, variations in the grain size of the minerals and, especially, intense retrograde metamorphic re-equilibrium. Thermobarometric estimations for the Caldas amphibole schist indicate metamorphism in the Barrovian amphibolite fades. The metamorphic path is counter-clockwise, but retrograde evolution could not be precisely defined. The pressures of the metamorphism in these rocks range from 6.3 to 13.5 kbar, with narrow temperature ranging from 550 to 630 degrees C. For the Ancon schist metapelites the P-T path is also counter-clockwise, with a temperature increase evidenced by the occurrence of sillimanite and the cooling by later kyanite. The progressive metamorphism event occurred at pressures of 7.6-7.2 kbar and temperatures of 645-635 degrees C for one sample and temperature between 500 and 600 degrees C under constant pressure of 6 kbar. The temperature estimated for these rocks varies between 400 and 555 degrees C at pressures of 5-6 kbar in the retrograde metamorphic path. The El Retiro rocks evidence strong decompression with narrow variation in temperature, showing pressure values between 8.7 and 2.7 kbar at temperatures of 740-633 degrees C. These metamorphic fragments of the basement in the Central Cordillera of the Colombian Andes could represent a close relationship with an antique subduction zone. (C) 2011 Elsevier Ltd. All rights reserved.

Petrology and geochemistry of the banded iron formation in the Eastern Sierras Pampeanas of San Luis (Argentina): Implications for the evolution of the Nogoli Metamorphic Complex

The metamorphosed banded iron formation from the Nogoli Metamorphic Complex of western Sierra de San Luis, Eastern Sierras Pampeanas of Argentina (Nogoli area, 32 degrees 55`S-66 degrees 15`W) is classified as an oxide facies iron formation of Algoma Type, with a tectonic setting possibly associated with an island arc or back arc, on the basis of field mapping, mineral and textural arrangements and whole rock geochemical features. The origin of banded iron formation is mainly related to chemical precipitation of hydrogenous sediments from seawater in oceanic environments. The primary chemical precipitate is a result of solutions that represent mixtures of seawater and hydrothermal fluids, with significant dilution by maficultramafic volcanic and siliciclastic materials. Multi-stage T(DM) model ages of 1670, 1854 and 1939 Ma and positive, mantle-like xi Nd((1502)) values of +3.8, +1.5 and +0.5 from the banded iron formation are around the range of those mafic to ultramafic meta-volcanic rocks of Nogoli Metamorphic Complex, which are between 1679 and 1765 Ma and +2.64 and +3.68, respectively. This Sm and Nd isotopic connection suggests a close genetic relationship between ferruginous and mafic-ultramafic meta-volcanic rocks, as part of the same island arc or back arc setting. A previous Sm-Nd whole rock isochron of similar to 1.5 Ga performed on mafic-ultramafic meta-volcanic rocks led to the interpretation that chemical sedimentation as old as Mesoproterozoic is possible for the banded iron formation. A clockwise P-T path can be inferred for the regional metamorphic evolution of the banded iron formation, with three distinctive trajectories: (1) Relict prograde M(1)-M(3) segment with gradual P and T increase from greenschist facies at M(1) to amphibolite facies at M(3). (2) Peak P-T conditions at high amphibolite-low granulite facies during M(4). (3) Retrograde counterpart of M(4), that returns from amphibolite facies and stabilizes at greenschist facies during M(5). Each trajectory may be regarded as produced by different tectonic events related to the Pampean? (1) and the Famatinian (2 and 3) orogenies, during the Early to Middle Paleozoic. The Nogoli Metamorphic Complex is interpreted as part of a greenstone belt within the large Meso- to Neoproterozoic Pampean Terrane of the Eastern Sierras Pampeanas of Argentina. (C) 2009 Elsevier Ltd. All rights reserved.

Caracterização de núcleos celulares no adenocarcinoma primário de reto por análise de imagem digital

O câncer colorretal é um tumor maligno freqüente no mundo ocidental. É o terceiro em freqüência e o segundo em mortalidade nos países desenvolvidos. No Brasil está entre as seis neoplasias malignas mais encontradas e a quinta em mortalidade. Dos tumores colorretais, aproximadamente 40% estão localizados no reto. A sobrevida, em cinco anos, dos pacientes operados por câncer do reto varia entre 40% e 50%, estando os principais fatores prognósticos, utilizados na prática clínica corrente, baseados em critérios de avaliação clínico-patológicos. A avaliação das alterações morfométricas e densimétricas nas neoplasias malignas tem, recentemente, sido estudadas e avaliadas através da análise de imagem digital e demonstrado possibilidades de utilização diagnóstica e prognóstica. A assinatura digital é um histograma representativo de conjuntos de características de textura da cromatina do núcleo celular obtida através da imagem computadorizada. O objetivo deste estudo foi a caracterização dos núcleos celulares neoplásicos no adenocarcinoma primário de reto pelo método da assinatura digital e verificar o valor prognóstico das alterações nucleares da textura da cromatina nuclear para esta doença. Foram avaliados, pelo método de análise de imagem digital, 51 casos de pacientes operados no Hospital de Clínicas de Porto Alegre (HCPA) entre 1988 e 1996 e submetidos à ressecção eletiva do adenocarcinoma primário de reto, com seguimento de cinco anos pós-operatório, ou até o óbito antes deste período determinado pela doença, e 22 casos de biópsias normais de reto obtidas de pacientes submetidos a procedimentos endoscópicos, para controle do método da assinatura digital. A partir dos blocos de parafina dos espécimes estocados no Serviço de Patologia do HCPA, foram realizadas lâminas coradas com hematoxilina e eosina das quais foram selecionados 3.635 núcleos dos adenocarcinomas de reto e 2.366 núcleos dos controles da assinatura digital, totalizando 6.001 núcleos estudados por análise de imagem digital. De cada um destes núcleos foram verificadas 93 características, sendo identificadas 11 características cariométricas com maior poder de discriminação entre as células normais e neoplásicas. Desta forma, através da verificação da textura da cromatina nuclear, foram obtidos os histogramas representativos de cada núcleo ou conjunto de núcleos dos grupos ou subgrupos estudados, também no estadiamento modificado de Dukes, dando origem às assinaturas digitais correspondentes. Foram verificadas as assinaturas nucleares, assinaturas de padrão histológico ou de lesões e a distribuição da Densidade Óptica Total. Houve diferença significativa das características entre o grupo normal e o grupo com câncer, com maior significância para três delas, a Área, a Densidade Óptica Total e a Granularidade nuclear. Os valores das assinaturas médias nucleares foram: no grupo normal 0,0009 e nos estadiamentos; 0,9681 no A, 4,6185 no B, 2,3957 no C e 2,1025 no D e diferiram com significância estatística (P=0,001). A maior diferença do normal ocorreu no subgrupo B de Dukes-Turnbull. As assinaturas nucleares e de padrão histológico mostraram-se distintas no grupo normal e adenocarcinoma, assim como a distribuição da Densidade Óptica Total a qual mostra um afastamento progressivo da normalidade no grupo com câncer. Foi possível a caracterização do adenocarcinoma de reto, que apresentou assinaturas digitais específicas. Em relação ao prognóstico, a Densidade Óptica Total representou a variável que obteve o melhor desempenho, além do estadiamento, como preditor do desfecho.

Infecção por HELICOBACTER PYLORI em crianças com dor abdominal crônica e sua associação com a gastrite endoscópica nodular

A infecção por Helicobacter pylori (Hp) é uma das infecções bacterianas mais comuns em todo o mundo. As maiores prevalências da infecção foram encontradas nos países em desenvolvimento, onde, em geral são altas já na infância. O método diagnóstico considerado mais acurado para a infecção por Hp, em crianças, é o exame endoscópico com biópsias gástricas. Alguns autores referem que o único aspecto macroscópico que pode predizer a infecção é o da presença de nodosidades na mucosa gástrica. Este aspecto é denominado de gastrite endoscópica nodular. A especificidade da gastrite endoscópica nodular para a infecção por Hp, entretanto, recentemente foi questionada por outros autores. Realizamos um estudo transversal em uma amostra de crianças (um a 12 anos) com dor abdominal crônica, que preenchiam os critérios para a realização de endoscopia digestiva alta, no Hospital da Criança Conceição e no Hospital de Clínicas de Porto Alegre, de setembro de 1997 a setembro de 1999. O objetivo principal foi verificar a associação entre a infecção por Hp e a gastrite endoscópica nodular nessas crianças. A amostra foi constituída de 185 crianças de ambos os sexos, com baixa renda familiar, cujos pais apresentavam baixo nível de escolaridade. Foi realizado estudo histológico das lâminas de biópsia gástrica (no mínimo cinco fragmentos, corados com H-E ou Giemsa), conforme o Sistema Sydney modificado. A infecção por Hp foi caracterizada pela presença de Hp na lâminas de biópsias gástricas dos pacientes e a gastrite folicular, pela presença de folículos linfóides bem formados, em mucosa gástrica inflamada. A prevalência da infecção por Hp nas crianças com dor abdominal crônica foi de 27% (IC 95%: 20,8-34,0). Foi demonstrada uma associação muito forte entre a infecção por Hp e a gastrite endoscópica nodular nessas crianças (P<0,001; RP = 29,7). Houve um aumento da prevalência tanto da infecção por Hp como da gastrite endoscópica nodular com a idade dos pacientes. A gastrite endoscópica nodular , embora tenha demostrado uma baixa sensibilidade (44,0%), apresentou um valor preditivo positivo de 91,7% para a infecção por Hp. Tanto o teste de urease, como a gastrite endoscópica nodular mostraram-se muito específicas, 94,5% e 98,5%, respectivamente, para o diagnóstico da infecção. Quando se combinou o teste de urease com o aspecto de gastrite endoscópica nodular, encontrou-se, uma sensibilidade muito baixa (34,7%), mas uma especificidade de 100% para a infecção por Hp. A sensibilidade do teste de urease, isolado, para a infecção foi de 60,4% e o seu valor preditivo positivo de 80,5%. O aspecto endoscópico (gastrite endoscópica nodular) teve associação com o microscópico (gastrite folicular) (P<0,001). Houve uma forte e significativa associação entre a infecção por Hp e a gastrite crônica ativa ( P<0,001; RP = 10,8). O mesmo foi demonstrado entre a gastrite nodular e a gastrite crônica ativa (P<0,001; RP = 8,6). Também foi verificado um nítido aumento das razões de prevalência da gastrite crônica ativa e da gastrite endoscópica nodular, com a acentuação dos graus de densidade de Hp. Finalmente, foi demonstrada a importante correlação entre o grau de intensidade da gastrite, verificado no exame histológico, e a gastrite endoscópica nodular (r = 0,97; P<0,001). A prevalência da infecção por Hp encontrada em Porto Alegre, nas crianças, foi menor do que a de outras cidades brasileiras e similar àquela registrada em algumas cidades do primeiro mundo. A presença de nodosidade na mucosa gástrica foi a alteração, à endoscopia, mais freqüentemente verificada nas crianças com infecção por Hp. Considerando a baixa prevalência da infecção encontrada na nossa amostra, a presença de gastrite endoscópica nodular significa uma elevada probabilidade de infecção por Hp, dado o alto valor preditivo verificado. O achado negativo para a gastrite endoscópica nodular, entretanto, não exclui a possibilidade da presença de infecção por Hp. Uma maior colonização bacteriana da mucosa gástrica estaria associada ao aparecimento da gastrite endoscópica nodular, já que a sua prevalência aumentou com os graus de densidade de Hp, assim como ocorreu com a gastrite crônica ativa. E quando ocorre, nas crianças, há maior probabilidade de se tratar de uma gastrite mais ativa e mais intensa.