Helicobacter pylori vacA and cagA genotypes in patients from northeastern Brazil with upper gastrointestinal diseases

Helicobacter pylori causes chronic gastric inflammation and significantly increases the risk of duodenal and gastric ulcer disease and distal gastric carcinoma. In this study, we evaluated the Helicobacter pylori vacA and cagA genotypes in patients from a Brazilian region where there is a high prevalence of gastric cancer. Polymerase chain reaction (PCR) was used to investigate vacA mosaicism and cagA status in the gastric mucosa of 134 H. pylori-positive patients, including 76 with gastritis: 28 with peptic ulcer disease and 30 with gastric cancer. The s1m1 variant was the predominant vacA genotype observed, whereas the s1 allele was more frequently observed in patients with more severe diseases associated with H. pylori infection [p = 0.03, odds ratio (OR) = 5.72, 95% confidence interval (CI) = 1.15-38.60]. Furthermore, all of the s1 alleles were s1b. Mixed vacA m1/m2 strains were found more frequently in patients with gastric cancer and a cagA-positive status was significantly associated with gastric cancer (p = 0.016, OR = 10.36, 95% CI = 1.35-217.31). Patients with gastric cancer (21/21, 100%, p = 0.006) or peptic ulcers (20/21, 95%, p = 0.02) were more frequently colonised by more virulent H. pylori strains compared to gastritis patients (41/61, 67.2%). In conclusion, in the northeastern of Brazil, which is one of the regions with the highest prevalence of gastric cancer in the country, infection with the most virulent H. pylori strains, carrying the cagA gene and s1m1 vacA alleles, predominates and is correlated with more severe H. pylori-associated diseases.

Boerhaave Syndrom: an unusual complication of acute vomiting in a child

Introduction: Boerhaave syndrome (BS) is a spontaneous esophageal perforation, described in aged, alcoholic males, secondary to forceful vomiting. BS has rarely been described in children. Case presentation: The patient is a 7-year-old Nigerian girl. She has a past history of clinical gastro-esophageal reflux (treated conservatively with prokinetics and good evolution), malaria at the age of 3 months and an episode of acute pancreatitis at 5 years. One week prior admission, she had stopped atovaquone-proguanil (AP) prophylaxis after a trip in an endemic area. Two days prior admission, she presented several bouts of isolated acute vomiting, without fever or diarrhea. On admission, she complained of chest pain. Cardiac auscultation revealed crepitus. No subcutaneous emphysema nor respiratory distress was present. Chest radiography and CT-scan confirmed a pneumomediastinum extending to the neck. Esophageal perforation was suspected. An upper gastrointestinal endoscopy was performed and showed a small esophageal tear, grade II-III esophagitis and a single gastric ulcer without any sign of H. Pylori infection. Enteral feeds were stopped and a nasogastric sucking tube inserted. The patient made a full recovery on intravenous antibiotics and conservative treatment. Of note a second episode of subclinical acute pancreatitis, treated conservatively, probably drug-induced. Discussion: BS is a complete rupture of all layers of the esophagus, secondary to an increased intra-abdominal pressure due to incomplete opening of the cricophayngeal sphincter occurring during vomiting or cough. Rarer causes include eosinophilic or Barrett's esophagitis, HIV and caustic ingestion. Esophageal perforation in children is rare, most of time secondary to necrotizing esophagitis in the newborn, medical intervention (endoscopy, sucking, or intubation) or trauma in the older child. Our patient had none of those risk factors and it is still unclear what predisposed her to this complication. However, we believe that preceding forceful vomiting with increased abdominal pressure acting on a weakened oesophagus due to esophagitis might be responsible. We could not find any association in the literature between AP and BS nor between BS and acute pancreatitis. The origin of her recurrent pancreatitis remains unclear, reason for which genetic testing for mutations in the trypsinogen, trypsin inhibitor and CFTR genes will be performed in case of a third episode.

Peritonite por bário

We report a case of a 49 years-old man who underwent a barium meal examination for an epigastric pain. A perforated gastric ulcer with barium extravasation into peritoneal cavity was seen on X-rays. During an emergency laparotomy, a perforated pyloric ulcer was noted, along with barium contamination in the peritoneal cavity. The ulcer was closed with an omental patch and an extensive peritoneal lavage with saline was performed. During the postoperative period, the patient developed signs of peritonitis and underwent a new laparotomy was at the 9th day showing a subfrenic abscess with a large barium contamination. The patient presented septic shock and multiple organ failure. dying on the 21th day.

Úlcera gástrica terebrante e pancreatite aguda provocadas por tricobezoar

Bezoar is a foreing body whitin the digestive tract originated from ingestion of varied substances, mainly vegetal fiber or hair. We present a case of a 14-year-old girl with trichotillomania, gastric trichobezoar, gastric ulcer and acute pancreatitis. The patient was operated on for anterior gastrotomy and removal of trichobezoar, with good postoperative follow-up. We illustrate this case to emphasize the need for recognition of gastric ulcer with acute pancreatitis and surgical management.

Postmortem findings in collared peccaries raised in captivity in northeastern Brazil

This study is a retrospective examination of diseases in collared peccaries that were diagnosed by the Veterinary Pathology Laboratory, Universidade Federal Rural do Semiárido. Necropsy and histological examination were performed from 2005 to 2010. Of the 50 necropsied collared peccaries, 24% died due to restraint and capture myopathy; 18% died from trauma; and the remainder was diagnosed with splenic hemangioma (6%), enterolithiasis (6%), gastritis (6%), gastric ulcer (4%), intestinal volvulus (4%), gastric volvulus (2%), mammary carcinoma (2%), polycystic kidney disease (2%), pyometra (2%), and suppurative bronchopneumonia (2%). Twelve animals remained undiagnosed, seven of which (14%) were in advanced autolytic condition and five of which (10%) had no gross or microscopic lesions that were compatible with disease. This paper describes illnesses that have not been reported in the collared peccary, focusing on their clinical and pathological aspects.

Étude des effets secondaires associés à un traitement prolongé de fluticasone inhalée chez les chevaux atteints de souffle (asthme équin)

Le souffle équin est une maladie inflammatoire chronique des petites voies respiratoires, très fréquente chez les chevaux gardés à l’intérieur avec de la paille et du foin moisi et poussiéreux. Les signes cliniques peuvent être prévenus par le contrôle de l’environnement et soulagés par l’administration de corticostéroïdes systémiques et inhalés. L’objectif de cette étude était de déceler les effets secondaires présents sur des chevaux atteints de souffle traités à la fluticasone (Flovent 250 μg HFA®, 2000 μg BID, pendant six mois, et puis 2000 μg SID, pendant six autres mois) par le cortisol sérique et la présence d’ulcères gastriques. Cinq chevaux exempts de maladie respiratoire et onze chevaux atteints du souffle ont été gardés à l’intérieur d’une écurie avec du foin moisi et de la paille dans le but de provoquer la maladie chez le groupe atteints du souffle. Une fois les chevaux atteints de souffle devenus symptomatique, ils ont été divisés en deux groupes : un premier groupe traité avec de la fluticasone, nourri avec du foin et gardé sur une litière de paille, et un deuxième groupe non traité nourrie avec de la moulée et gardé sur une litière de ripe, pendant six mois. Par la suite, les deux groupes ont été mis au pâturage. Le cortisol a été mesuré par Immunoessai enzymatique par chimiluminescence (CEIA, Immunolite 1000, Siemmens®) les 12e et 10e jours avant et les 7e, 28e, 80e, 160e, 200e, 250e, 290e et 320e jours après le début du traitement afin de déterminer le degré de suppression du cortisol sérique. On a également fait une suivi de la présence d`ulcères gastriques à l`aide de vidéo endoscopique. La fluticasone inhalée deux fois par jour cause une diminution du cortisol sérique les 28e, 80e et 160e jours, mais elle n’entraîne pas d’effets sur le score des ulcères gastriques. Les pellets de luzerne causent quant à elles, une augmentation du score des ulcères gastrique chez les animaux exempts de maladie respiratoire.

Freqüência de lesões gástricas em suínos destinados ao abate na região de Ribeirão Preto, SP

Foram colhidos e examinados 1085 estômagos de suínos, machos castrados ou fêmeas, todos com idade entre 140 e 150 dias. As lesões encontradas foram classificadas de acordo com a localização, tipo e severidade. A análise macroscópica revelou que 694 (64%) estômagos apresentavam algum tipo de lesão. A paraqueratose foi identificada como alteração patológica única em 213 (19,6%) estômagos. em outros 319 (29,4%) estômagos, ela estava associada apenas a processos erosivos ou associada a erosões e úlceras. Erosões isoladas ou associadas a ulcerações foram identificadas em 121 (11,2%) animais, enquanto que úlceras, foram verificadas em 41 (3,8%) animais. A avaliação por regiões, revelou que 62,8% apresentaram lesões na região gastresofágica e apenas 6,6% na região fúndica do órgão. Tais achados sugerem a existência de diferentes causas na etiopatogenia desses dois processos gástricos. A ulceração gastresofágica estava presente em 213 (19,6%) animais, dos quais 22,7% eram machos castrados e 16,5% eram fêmeas, fato que evidencia possível influência do sexo na freqüência dessa patologia em suínos. Os exames microscópicos, realizados em parte das amostras, apenas confirmaram as alterações, já identificadas pelo exame macroscópico. Apenas o exame macroscópico conduz a resultados confiáveis na avaliação de lesões gástricas em suínos.

Evaluation of the genotoxic and antigenotoxic potential of Brassica oleracea L. var. acephala D.C. in different cells of mice

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Antiulcerogenic Activity of the Essential Oil of Baccharis dracunculifolia on Different Experimental Models in Rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Vitamin B-12 Supplement Exerts a Beneficial Effect on the Seminiferous Epithelium of Cimetidine-Treated Rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Antioxidative action of methanolic extract and buthanolic fraction of Vochysia tucanorum Mart. in the gastroprotection

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Gastroprotective effect of Cissus sicyoides (Vitaceae): Involvement of microcirculation, endogenous sulfhydryls and nitric oxide

Aim of the study: Cissus sicyoides L. is a medicinal plant popularly known in Brazil against various diseases and the research interest in this plant is justifiable because of its potential medicinal value in stomachache and gastric ulcer.Materials and methods: The methanolic extract obtained from the leaves of Cissus sicyoides (Cc) was evaluated for the ability to protect the gastric mucosa against injuries caused by necrotizing agents (0.3 M HCl/60% EtOH, absolute ethanol, piroxicam and pylorus ligature) in rodents. We also evaluated microcirculation, antioxidant action and participation of NO (nitric oxide) and sulfhydryls (SH) groups in the Cc gastroprotective action.Results: Administration of Cc significantly reduced gastric lesions induced by different ulcerogenic agents in rodents. This extract administered by oral route significantly increased gastric volume without exerting antisecretory effect. The Cc effect involved an increase of the defense mechanism of the gastrointestinal mucosa such as NO and SH groups that prevent and attenuate the ulcer process. The Cc also has antioxidant property against oxidative stress but does not modify microcirculation response in gastric mucosa.Conclusions: These results confirmed the traditional use of Cissus sicyoides for the treatment of gastric ulcer. (C) 2008 Elsevier B.V. All rights reserved.

Antiulcerogenic effect and cytotoxic activity of semi-synthetic crotonin obtained from Croton cajucara Benth.

Trans-dehydrocrotonin, the major diterpene isolated from the bark of Croton cajucara, has good antiulcerogenic activity which, however, is accompanied by toxic effects. on the basis of these results, a semi-synthetic crotonin, named 4SRC, was prepared to determine whether this substance has similar antiulcerogenic activity with lower or no toxicity. The natural crotonin was also isolated from the bark of C. cajucara but was not used due to the small amount obtained. The cytotoxic effect of semi-synthetic crotonin, expressed as cell viability, was assessed in (a) lung fibroblast cell line (V79) derived from Chinese hamsters, a system commonly used for cytotoxicity studies, and (b) rat hepatocytes isolated from male Wistar rats. After treatment, cell viability was determined by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide reduction (MTT reduction), total acid content and neutral red uptake assays. To evaluate V79 cell viability, different concentrations of semi-synthetic crotonin were incubated with the cells. To evaluate the antiulcerogenic effects of semi-synthetic crotonin (50, 100 and 200 mg/kg), we used the models of gastric ulcer induced by ethanol/HCl, stress, indomethacin/bethanechol, and ethanol in male Swiss mice and male Wistar rats. The substance had an IC50 = 500 muM in the neutral red uptake and MTT reduction tests and an IC50 = 200 muM in the nucleic acid content test. With regard to hepatocyte viability after treatment with semi-synthetic crotonin at different concentrations, semi-synthetic crotonin had an IC50 = 10-500 muM in the nucleic acid content and MTT reduction tests and an IC50 = 120 muM in the neutral red uptake test. In another experiment, V79 cells were incubated with the metabolites produced by hepatocytes treated with different concentrations of semi-synthetic crotonin. After a 4-h incubation, semi-synthetic crotonin had an IC50 = 500 muM in the MTT reduction and neutral red uptake tests and an IC50 = 370 muM in nucleic acid content test. The substance had significant antiulcerogenic activity in all models studied, suggesting the presence of a possible antisecretory effect combined with a cytoprotective effect. For this reason, the effect of semi-synthetic crotonin was also evaluated on biochemical parameters of gastric juice and gastric wall mucus, both obtained from pylorus-ligated mice. No significant differences were observed in these parameters between semi-synthetic crotonin-treated and control animals. The results obtained with semi-synthetic crotonin are promising, with a significant preventive effect against gastric ulcer induced by different agents. Our data also show that semi-synthetic crotonin was less toxic than dehydrocrotonin and that the cytotoxic effects decreases with the time that isolated hepatocytes were in culture. (C) 2003 Elsevier B.V. B.V. All rights reserved.

Antiulcerogenic activity of four extracts obtained from the bark wood of Quassia amara L. (Simaroubaceae)

Quassia amara L., a neotropical forest shrub of the Simaroubaceae family, is widely used in Caribbean folk medicine and in some northern states of Brazil for the treatment of gastric ulcers. This plant is a source of numerous compounds including both beta-carbonile and cantin-6 alkaloids as well as, primarily, the bitter compounds known as quassinoids. We analyzed the possible antiulcerogenic activities of four extracts of different polarities: 70% ethanol (70% EtOH), 100% EtOH, 100% dichloromethane (DCM), and 100% hexane (HEX) obtained from Quassia amara bark. All extracts, administered at doses of 5000 mg/kg orally and 1000 mg/kg intraperitoneally, caused neither toxicity or death. In the indomethacin[bethanechol-induced gastric ulcer, 70% EtOH, 100% EtOH, DCM and HEX extracts, 100 mg/kg, p.o., inhibited the gastric ulcer (22.5, 23.4, 50.5, 46.8%, respectively). 70% EtOH, 100% EtOH, DCM, and HEX extracts reduced the gastric injury induced by the hypothermic restraint-stress test in mice (70.7, 80, 60, 82.7%, respectively). In the pylorus ligature of the mouse stomach, following pre-treatment with a single intraduodenal administration of 100 mg/kg of each extract, only 70% EtOH did not change the biochemical parameters of gastric juice. 100% EtOH, DCM and HEX extracts presented decreased gastric juice content, increased pH values and decreased acid output. We also determined the antiulcerogenic activity on HCl-EtOH-induced gastric ulcers in mice at four doses (25, 50, 75, 100 mg/kg, p.o.), then evaluated the possible dose-dependent relation and calculated the ED50 values. Except for 70% EtOH at a dose of 25 mg/kg, the other extracts showed significantly activity (p<0.05). The free mucous amount in the gastric stomach content was also evaluated. All extracts showed significant increases (p<0.05) of free mucous. This effect was abolished when the animals were pre-treated with indomethacin. Prostaglandin synthesis was evaluated by the administration of HEX extracts by the oral route (100 mg/kg). Prostaglandin synthesis was significantly, increased by 52.3% (p<0.05), and this effect was abolished with prior administration of indomethacin. We concluded that Quassia amara is a probable source for a new drug to treat gastric ulcers, and the mechanism of its activity relates to cytoprotective factors, such as mucous and prostaglandins, but there is still the possibility that antisecretory activity is involved in its antiulcerogenic effect.

Gastroprotective mechanisms of Citrus lemon (Rutaceae) essential oil and its majority compounds limonene and beta-pinene: Involvement of heat-shock protein-70, vasoactive intestinal peptide, glutathione, sulfhydryl compounds, nitric oxide and prostaglandin E-2

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)