Role of serum pepsinogen in detecting ulcer disease.
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Biomedical subjects
Publications and source records attributed to F Di Mario.
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The relationship between some psychosocial factors and serum level of Pepsinogen Group I (PG-I) and gastrinemia have been evaluated in 163 normal subjects using correlation procedures. The psychosocial variables investigated included: age, sex, education, social class, smoking, drinking, anxiety (as measured by the State Trait Anxiety Inventory) and psychological distress (as measured by the Symptom Distress Check-List 90). The variables with the highest (positive) correlation with PG-I were smoking and age. The factors mostly linked with gastrinemia were age (positively correlated) and trait anxiety (negatively correlated). The percentage of variation explained by these variables was, however, relatively low.
Gastric juice CA 19-9 levels were determined in 23 patients affected by gastric cancer, in 57 patients affected by chronic atrophic gastritis of different severities and in 55 'healthy' controls, undergoing endoscopy for upper gastrointestinal tract symptoms. Increased CA 19-9 levels were documented in chronic atrophic gastritis patients as well as in gastric cancer patients, the difference with respect to controls being statistically significant. However, there was considerable overlap between different groups. In particular, gastric cancer patients had CA 19-9 levels similar to those detected in moderate and severe chronic atrophic gastritis. CA 19-9 correlated with gastric juice pH and CEA concentration. Its values were not influenced by the patients' age or sex. In our opinion CA 19-9 gastric juice determination, although not useful in singling out patients harboring gastric neoplasia, may be used in identifying patients 'at risk' for gastric cancer and who might then be referred for more accurate investigations.
138 consecutive patients with endoscopically and histologically confirmed benign gastric ulcer were investigated in order to evaluate the relationship between aging and parameters relating to gastric ulcer pathophysiology and natural history: prevalence in dyspeptic patients referred to an endoscopic unit, recurrences, gastric acid secretory capacity, peptic activity, incidence of precancerous and neoplastic changes. On the basis of our results, different populations of gastric ulcer patients seem to be identifiable: (1) young patients (aged under 40), with low prevalence and recurrence rates, with acid capacity above normal range, high peptic activity and no risk for precancerous or neoplastic changes, (2) middleaged subjects (41-50), with high prevalence and recurrence rates, high peptic activity and acid activity within the normal range, atrophic gastritis, intestinal metaplasia, dysplasia and low incidence of cancer, and (3) elderly patients (aged over 50), with lower prevalence and recurrence rates, frequent association with chronic atrophic gastritis, impaired acid and peptic secretion, in whom one may observe either an association of the ulceration with cancer or evolution of dysplasia into neoplasia. These observations confirm that elderly and middle-aged gastric ulcer patients should undergo routine follow-up, and that pathophysiological data should be taken into account before deciding upon antiulcer therapy.
The personality profiles, as evaluated with Cattell's 16 personality factors test (16 PF), were compared in 25 subjects with gastric ulcer, 25 with duodenal ulcer and 25 healthy controls. Subjects were matched for sex, age, education, geographical area of living and duration of illness (only for patients). The profiles of the gastric and duodenal ulcer patients were substantially similar and characterized by greater anxiety, dependence, introversion, low ego strength and greater adaptability as compared to the controls. Patients with gastric ulcer, however, seemed to be slightly more disturbed than those with duodenal ulcer.
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In this paper the clinical usefulness of CEA and ferritin in the diagnosis of pancreatic cancer was pointed out. CEA was found to be increased in 51% of patients with pancreatic cancer; it was also abnormal in 22% of chronic pancreatitis and 31% of extra-pancreatic diseases. In patients with metastatic pancreatic cancer CEA was found to be more elevated than in those with localized tumor. CEA correlated with the age of the subjects in all material; in liver cirrhosis with IgG and in extra-pancreatic gastro-intestinal malignancies with alkaline-phosphatase. Ferritin was found to be increased in 73% of pancreatic cancer patients; it was also abnormal in 40% of chronic pancreatitis and in 38% of extra-pancreatic diseases. Patients with chronic pancreatitis studied during a relapsing phase all had elevated serum ferritin. We can conclude that neither CEA nor ferritin are useful indices of pancreatic malignancy, due to the lack of sensitivity or specificity. Both are influenced by several factors: CEA mainly by age and liver dysfunction, ferritin by the presence of an acute inflammation with cell necrosis.
The study of cytology in duodenal and/or pure pancreatic juice has been proposed in the differential diagnosis of pancreatic cancer. In our experience the sensitivity of cytology in duodenal juice, collected during Secretin-Cholecystokinin test, in diagnosing pancreatic cancer was 66.6%. False positive results were obtained only rarely (1.4%) in patients with chronic pancreatitis and benign diseases of the gastrointestinal tract. The cytological evaluation of pure pancreatic juice, obtained by ERCP, increases sensitivity up to 80-90%, especially when the combination of the results of ERCP and cytology is performed. Cytological examination of duodenal and/or pure pancreatic juice is a useful tool in detecting pancreatic malignancy and in differential diagnosis with chronic pancreatitis.
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One hundred and forty-four patients with apparently benign gastric ulcer were endoscopically followed up in order to evaluate the outcome of the lesion. Particular attention was given to: (a) detect possible delay in diagnosing gastric cancer; (b) ascertain the frequency of association with epithelial dysplasia; (c) establish the role of markers, such as serum pepsinogen group I (PGI), and gastric juice CEA in predicting gastric ulcer evolution. Endoscopic and bioptic check-ups were carried out during the first year at 3, 6 and 12 months after endoscopic healing of the ulcer, and then at every symptomatic recurrence. Ten patients (6.9%) were found to present histological evidence of malignancy (within 3 months in six cases, between 6 and 12 months in three cases, and after 41 months in the rest). Four cases were early gastric cancers, and six had shown dysplastic changes of the mucosa at the edge or scar of the ulcer. Serum PGI levels were not significantly different in gastric cancer patients, while gastric juice CEA levels were sharply increased compared to those of gastric ulcer patients: nine out of ten patients had values above normal range. These data suggest that: (a) there may be some delay in diagnosing gastric carcinoma, and gastric ulcer patients should be controlled routinely more than once; (b) the presence of dysplasia indicates the need for prolonged follow-up, because of the high risk of association with or evolution into gastric cancer, and because of the higher number of early gastric cancer detections that this protocol allows; (c) further support in monitoring patients "at risk" may be afforded by gastric juice CEA determination.
The endoscopic diagnosis of chronic atrophic gastritis is often underestimated, and most of the procedures adopted to increase diagnostic accuracy are time consuming and complex. In this study, we evaluated the usefulness of the determination of gastric juice pH by means of litmus paper. Values obtained by this method correlate well with gastric acid secretory capacity as measured by gastric acid analysis (r = -0.64, p less than 0.001) and are not affected by the presence of bile. Gastric juice pH determination increases sensitivity and other diagnostic parameters such as performance index (Youden J test), positive predictive value, and post-test probability difference by 50%. Furthermore, the negative predictive value is very high, the probability of missing a patient with chronic atrophic gastritis with this simple method being 2% for fundic and 15% for antral atrophic change. We conclude that gastric juice pH determination, which substantially increases diagnostic accuracy and is very simple to perform, should be routinely adopted.
The aim of the study was to identify the clinical markers useful in characterising slow healing and relapsing gastric ulcer patients. Ninety nine subjects entered the short term and 79 the long term study (12 months). The following parameters were taken into account: therapy, sex, age, smoking habit, alcohol consumption, analgesic intake, peptic ulcer family history and onset of the disease. Results of the studies were analysed by means of chi 2 test and logistic regression, both in stepwise and in specifying models. Cigarette smoking was found to be the most important risk factor of non-healing (p = 0.04). In women with late onset of the disease, cigarette smoking identified the gastric ulcer subjects at higher risk of non-healing with a predictive probability of 0.4679. Age under 50 years was found to be the most important risk factor of relapsing throughout the entire 12 month follow up period (p = 0.025). In those under 50 years, cigarette smoking and negative peptic ulcer family history in combination, identified the gastric ulcer subjects at higher risk of relapsing, the predicted probability being 0.6027. It is concluded that cigarette smoking is the most important risk factor for non-healing and those who relapse under the age of 50. The possibility of singling out categories of patients more prone not to heal and to relapse suggests new strategies in the management of gastric ulcer disease.
Two groups of duodenal ulcer (DU) patients, responders and nonresponders, have been compared in order to verify if psychological factors are linked to relapse. Responders are defined as those patients who on endoscopy did not present proven relapse during treatment with maintenance doses of antisecretory drugs (cimetidine 400 mg/day, ranitidine 150 mg/day, pirenzepine 50 mg/day) for a period of 12 months after healing of the lesion. Nonresponders were all patients presenting with at least one relapse during treatment with antisecretory drugs. One hundred and twelve DU patients (81 responders, 31 nonresponders) were examined with the Cattell 16 Personality Factors Questionnaire (16PF) form C. There were no significant differences between the two groups for age, sex, duration of illness and type of drug treatment. The 16 PF scores of responders and nonresponders were not statistically different except in the case of factor E (dominance), in which the nonresponder subjects scored higher than responder subjects (p less than 0.01). However, when the significance level was corrected for the number of variables involved, the above finding is not considered to be meaningful.
The personality pattern of duodenal ulcer (DU) patients on maintenance treatment who relapsed (N = 22) was compared to a similar group who did not relapse (N = 57) using the Sixteen Personality Factors Questionnaire. Multivariate analysis of data indicated that a subgroup of DU patients with personality marked by dependent and anxiety traits was more prone to relapse of illness.
The aim of the present work was to study gastric acid secretion in control subjects and in gastric and duodenal ulcer patients and to evaluate sex, age, body weight, blood group, cigarette smoking and the intake of H2-blockers in the 24 hours preceding gastric acid analysis. The results obtained seem to indicate that 6 micrograms/kg b.w./i.m. Pentagastrin is the best stimulus and that basal secretion may be assessed in thirty minutes, without altering the BAO value. Factors such as cigarette-smoking and H2-blockers intake on the one hand and body weight and male sex on the other influence gastric juice output and should therefore be considered in interpreting the results.