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Biomedical subjects

P Sipponen

Publications and source records attributed to P Sipponen.

At least 163 records · Page 9Linked to original sources
PubMed1989

Chronic antral gastritis, Lewis(a+) phenotype, and male sex as factors in predicting coexisting duodenal ulcer.

Chronic antral gastritis, Lewis(a+) phenotype (Le(a+)), and male sex are common in patients with peptic ulcer. To approximate the relative risks (RR) and possible interactions of these factors in predicting coexisting active duodenal (DU) or gastric ulcer (GU), a consecutive endoscopic series of 140 ulcer patients and 215 non-ulcer controls was examined. The Lea phenotype (Le(a+) versus Le(a-)) was determined immunohistochemically as binding of Le(a)+-specific monoclonal antibody to surface epithelial secretory mucosubstances in gastric biopsy specimens. The presence versus absence of the gastritis was determined histologically from antral specimens. The RRs of the factors in the prediction of ulcer were approximated as age-adjusted RRs when the risk of ulcer in the absence of the factors--that is, in the absence of gastritis, in female sex and in Le(a-) phenotype--was applied as a base line (RR = 1). A case-control design, logistic linear modelling, and the maximal likelihood method were used in estimation of the risks. The RR of coexisting distal ulcer (DU or pyloric or prepyloric GU) was increased in the presence of gastritis (RR = 10.2), in male sex (RR = 3.0), and in Le(a+) phenotype (RR = 1.8). The RR of proximal ulcer (angular or corpus GU) was increased in the presence of gastritis (RR = 35) but decreased in the presence of male sex (RR = 0.5) and Le(a+) phenotype (RR = 0.7). As predictors of both distal and proximal ulcer, gastritis, sex, and Le(a) phenotype were independent of each other; that is, their joint value in prediction of ulcer is a multiplicand of the marginal risks. Thus, a 50-fold difference in the joint RR could be approximated between the extreme risk groups for distal ulcer--that is, between Le(a+) males with gastritis and Le(-a) females with normal antrum. In a consecutive series of outpatient endoscopies, 45% of females and 8% of males could be categorized to these extreme 'low'- and 'high'-risk groups, respectively. We conclude that sex, Le(a) phenotype, and gastritis are factors that, at least in ordinary outpatient endoscopy material, divide subjects to subgroups with very different risks and probabilities for having coexisting peptic ulcer.

Adult↗
PubMed1989

Atrophic gastritis as a premalignant condition.

Chronic (atrophic) gastritis is a progressive disease which in a small proportion of patients leads to severe (total) atrophy (severe grade of chronic gastritis) of the antral or body mucosa or both. Chronic gastritis is a premalignant condition which favours the development of gastric cancer. Chronic gastritis precedes gastric cancer and shows a severalfold increase in the risk of gastric cancer compared to subjects with histologically normal stomach. Several tentative modifications to the estimate of the risks may be presented: (i) a severe risk of developing gastric cancer is restricted to subjects with a severe grade of chronic gastritis (ii) the risk of gastric cancer is increased in subjects who have either severe antral or body chronic gastritis, the risk being approximately three to five times higher in the antral chronic gastritis (B-type of gastritis) than in the body chronic gastritis (A type of gastritis); (iii) the antral and body chronic gastritis are independent risk factors for gastric cancer, the joint risks being multiplicands of the marginal risks i.e., the estimated risk is highest in those subjects who show severe chronic gastritis in both the antrum and the body (AB type of gastritis); (iiii) the chronic gastritis mediated gastric cancer risk is limited to gastric cancers of the intestinal type, and thus covers only a proportion of all cases of gastric cancer. In the highest risk groups it may be estimated that the probability of a subject developing gastric cancer in subsequent decades is up to 30% if the subject is a young man who has severe chronic gastritis in his antrum, or who has it coexistently in the antrum and body.

Gastritis↗
PubMed1988

Fecal bacteriology and reservoir ileitis in patients operated on for ulcerative colitis.

To investigate the etiology of ileal reservoir inflammation, fecal bacteriology and ileal wall morphology were compared in three groups of 15 patients operated on for ulcerative colitis: 1) conventional ileostomy, 2) Kock ileostomy; and 3) pelvic ileal pouch. Total bacterial counts showed overgrowth of fecal bacteria in each group, but the anaerobic bacterial counts were significantly higher (P less than .05) in the two pouch groups than in the conventional ileostomy group. Mucosal morphology did not differ among the three groups showing either normal mucosa or mild chronic inflammatory changes in most patients. In contrast, five of the six patients with clinical pouchitis had acute inflammatory changes in histologic specimens. Fecal bacteriologic findings in these patients did not differ quantitatively or qualitatively from others. It is concluded that proctocolectomy for ulcerative colitis predisposes to ileal bacterial overgrowth, and after pouch operations especially, anaerobic overgrowth may be one factor in the development of pouch inflammation. Acute clinical pouchitis with clear histologic changes was, however, not connected with specific changes in fecal bacteriology.

Adult↗
PubMed1988

Increased risk of gastric cancer in males affects the intestinal type of cancer and is independent of age, location of the tumour and atrophic gastritis.

Male sex, high age and atrophic gastritis (AG) are risk conditions for gastric carcinoma (GCA). We have studied the magnitude of the sex-bound risk of GCA and whether this risk is an independent risk factor for GCA or whether it is related to the risks that are mediated by age and AG. The observed frequencies of males and females in different age groups, and in presence or absence of AG, among 532 GCA patients (273 cases of intestinal (IGCA) and 259 cases of diffuse (DGCA) type) were compared with the expected frequencies which were calculated by applying the data of age-specific distributions of the sexes and AG in the general population. A significant 1.6-fold overrepresentation of males and 0.6-fold underrepresentation of females were seen in IGCA but not in DGCA. The overrepresentation of the male sex and the underrepresentation of the female sex in IGCA were independent of age of the patient and location of the tumour in the stomach. These phenomena were also independent of AG: the overrepresentation of males and the underrepresentation of females were observed in IGCA patients with normal, non-atrophic mucosa as well as in IGCA patients with AG. We conclude that the sex is an independent risk factor for IGCA, and that the phenomena which lead to overrepresentation of males and underrepresentation of females among IGCA patients (and among GCA patients in general) are unrelated to age, AG and location of the tumour in the stomach.

Adult↗
PubMed1988

Gastroscopic screening for gastric carcinoids and carcinoma in pernicious anemia.

Among 196 patients examined in 1972-1985 because of pernicious anemia (PA), 105 patients under the age of 76 years were invited for gastroscopic screening, and 71 patients (68%) participated. Gastroscopy revealed carcinoid tumor(s) in 5 patients (7%) but no case of carcinoma. In addition, one patient with gastric carcinoid, 5 patients with adenocarcinomas and one with a concomitant carcinoid and carcinoma had already been diagnosed earlier in the overall PA group on the basis of clinical symptoms. Thus, within a follow-up of 0-20 years (mean 7 years) the total frequency of gastric carcinoid tumors was 4% and that of carcinoma 3%. Patients with carcinoid tumors had a long duration of PA and young age of onset; these cases were not necessarily those with the highest serum gastrin levels. Even though most gastric carcinoids are small subclinical tumors of uncertain clinical significance, their unexpectedly high frequency, combined within the risk of carcinoma in PA, might indicate the need for gastroscopic follow-up, at least in cases of juvenile onset PA.

Adult↗
PubMed1988

Reduced thickness of gastric mucosa and retarded progression of chronic gastritis in patients with renal failure.

Conflicting results are reported in the literature on the structure and function of gastric mucosa in patients with chronic renal failure (CRF). In the present endoscopic study of 68 CRF patients on conservative treatment (regular dialyses or transplantations had not yet been undertaken), we sought to clarify whether CRF leads to hypertrophic or hypotrophic phenomena in gastric mucosa, as interpreted by the presence and grade of gastritis and by the thickness of the gastric mucosa. We found that the mean progression of gastritis in both antrum and body was significantly slower than expected in CFR patients, and that the thickness of both antral and body mucosa was significantly lower in CFR patients than in non-CRF controls. Furthermore, although the thickness of the oxyntic body mucosa in CRF showed a positive correlation to serum gastrin (SeGa) levels and even though 12 of the patients showed high SeGa levels corresponding to those seen in the Zollinger-Ellison synbdrome (300-1500 ng/l), the thickness of the oxyntic body mucosa in CRF patients did not exceed that seen in control subjects with normal SeGa. We conclude that CRF exerts inhibitory effects on the gastric mucosa resulting in retardation in the progression of chronic gastritis and hypotrophy of the gastric mucous membrane.

Adult↗
PubMed1988

Campylobacter pylori is associated with chronic gastritis but not with active peptic ulcer disease.

Campylobacter pylori is supposed to be involved in the pathogenesis of gastroduodenal peptic ulcer diseases and chronic gastritis. In order to study whether the Campylobacter pylori in the stomach of peptic ulcer patients is related to ulcer itself or to a co-existing chronic gastritis, we examined the frequency of the bacteria in Giemsa stained histological sections of biopsy specimens from a series of patients with active peptic ulcer and from series of non-ulcer control subjects. We found no difference in the frequency of Campylobacter- positive cases between ulcer patients and non-ulcer controls when the comparison was done within the same category of chronic gastritis; e.g., within the category of chronic superficial gastritis 74% and 78% of cases showed the bacteria in antral biopsies from ulcer patients and from non-ulcer controls, respectively. In both ulcer patients and control subjects, in similar way in both antral and body mucosa, the Campylobacter pylori was strongly associated with chronic superficial gastritis but was more weakly associated with chronic atrophic gastritis, and the bacteria were only occasionally seen in normal mucosa. We conclude that Campylobacter pylori is associated with chronic gastritis in peptic ulcer patients but is not related to active ulcer.

Adult↗
PubMed1988

Campylobacter pylori in a sample of Finnish population: relations to morphology and functions of the gastric mucosa.

The occurrence of Campylobacter pylori (CP) was examined in 179 subjects representing a sample collected from the population of South Finland. In a normal antral and body mucosa CP was present in 5% and 11% and in superficial gastritis (SG) in 71% and 91% of subjects, respectively. In atrophic gastritis (AG) of antrum and body the prevalence of CP decreased significantly with an increasing degree of atrophy, so that CP was not found in severe body AG. Different combinations of antral and body gastritis revealed a characteristic pattern. Campylobacter pylori was lacking when antral and body mucosa were normal, but was present in 41% when normal mucosa was associated with gastritis in the opposite area. In SG affecting diffusely antrum and body, the bacterium was present in every case, but when SG was associated with AG in the opposite area it was lacking in 29% of the subjects. When SG affecting both areas was compared with SG accompanied by different degrees of AG in the body, there was a highly significant decrease of the prevalence of CP in antrum and body along with an increasing degree of AG in the body. This decrease showed a highly significant positive correlation with the acid output. On the whole, acid output correlated well with the occurrence of CP in both antrum and body. Thus the prevalence of CP was 10% in achlorhydria and rose up to 100% in cases with acid output above 30 mmol/h. The presence of CP did not correlate with signs of acute inflammation, but correlated significantly with those of chronic inflammation. No correlation was found in the antrum and a significant negative one in the body, between CP infestation and the extension of intestinal metaplasia. It is concluded that increased pH of gastric contents and mucus secreted by intestinalised glands may create unfavourable conditions for survival of the bacteria and might explain the decrease in the prevalence of CP in the more severe degrees of AG. The present results, however, give no definite answer to the question of the pathogenic significance of CP in the development of chronic gastritis.

Adult↗
PubMed1988

Mucosal alterations in pelvic ileal reservoirs. A histological and ultrastructural evaluation in an experimental model.

To study mucosal changes in ileal pouches, three different types of pelvic ileal reservoir (2-loop, 3-loop and 4-loop), interposed in place of resected rectum, were constructed in 12 piglets, 4 animals in each group (n = 12). After a 6 week interval the animals were sacrificed and the reservoirs removed and processed for light and scanning electron microscopy (SEM). Both acute and chronic inflammatory changes were present but not prominent in the pouch mucosa. With the exception of mucosal ulcers both the histological and SEM-findings greatly resembled the atrophic, flat mucosa seen in ileal coeliac disease. Macroscopic findings did not correlate with histological findings. Colonization by bacteria and bacterial overgrowth were noticed in every pouch suggesting a possible link between bacterial invasion and pouch ileitis. No correlation was found, however, between the amount of intraluminal bacteria and the severity of the pouchitis.

Animals↗
PubMed1987

Decreased incidences of intestinal and diffuse types of gastric carcinoma in Finland during a 20-year period.

The incidence of gastric carcinoma (GCA) has decreased throughout the world. This decrease is attributed to a decline in incidence of the intestinal type of GCA (IGCA), whereas the diffuse (DGCA) type of GCA is considered to be endemic in nature and more stable in incidence. In the present study we have estimated how much the incidences of IGCA and DGCA have decreased in percentage in Finland from 1952-61 to 1972-81. Our calculations are based on the Finnish Cancer Registry data of new GCA cases, on population statistics in Finland, and on the percentage distribution of GCA subtypes in three consecutive samples of GCA patients collected in the time periods 1952-61 (reference series) and 1972-81 (two separate samples: series A and B). The samples totaled 1837 GCA cases. We calculated that the incidence of IGCA had decreased from 1952-61 to 1972-81 by 62-71% (reference series versus series A - reference series versus series B) among men and by 69-70% among women. Correspondingly, the incidence of DGCA was calculated to have decreased by 30-39% among men and 37-42% among women. We conclude that not only has the incidence of IGCA decreased in percentage approximately twice as much as the incidence of DGCA but DGCA has also distinctly decreased in incidence in Finland from 1952-61 to 1972-81.

Adult↗
PubMed1987

Prepyloric erosions: an entity of its own among erosive gastric lesions. A morphologic and dynamic study of gastric mucosa in patients with gastric erosions.

The morphology and dynamics of the gastric mucosa were examined in 130 patients with gastric mucosal erosions by using mathematical methods based on stochastic principles. The results were compared with those of controls representative of the general population. The progression of antral gastritis was less rapid in erosion patients than in the controls (p less than 0.001), but body gastritis increased with age, as expected. In patients with prepyloric erosions body gastritis showed less rapid progression with age than in the controls (p less than 0.01) or in other erosion patients (p less than 0.05). Antral gastritis increased, as in the controls, and more rapidly than in other erosion patients (p less than 0.01). The preservation of the body mucosa in patients with prepyloric erosions despite ageing is similar to that seen in patients with duodenal ulcer disease, suggesting a common acid-related pathogenesis.

Adult↗
PubMed1987

Sensitivity of gastric acid secretion in patients with chronic renal failure.

By means of a dose-response secretion test the sensitivity of gastric acid secretion was investigated in 85 patients with chronic renal failure and in 85 age- and sex-matched controls. The renal patients were also gastroscoped, with biopsy specimens taken from the gastric body. The examinations were repeated on 18 patients undergoing regular dialysis and 8 patients after successful transplantation. The acid secretion sensitivity of the stomach among the non-dialyzed patients was decreased when compared with the controls (p less than 0.01) but tended to normalize during the intermittent dialysis treatment (p less than 0.05) and particularly after transplantation (p less than 0.01). The low secretion responses were independent of gastric body histology and were also seen in patients with normal body mucosa. The maximum theoretic acid output did not differ significantly from that of the controls. It is concluded that there is an inhibition of gastric acid secretion in chronic renal failure. This inhibition depends on the decreased sensitivity to stimulation and is diminished by treatment of renal failure by dialysis or transplantation.

Adult↗
PubMed1987

Gastroduodenal peptic ulcers, duodenal adhesions, and upper gastrointestinal motility disturbances in patients who have undergone cholecystectomy.

The frequency of duodenal and gastric ulcer disease, the thickness of the pyloric muscle, and adhesions of the duodenum were evaluated in a routine, consecutive, prospective autopsy series of 100 patients, and the length of the pyloric canal, adhesions of the duodenum, and motility disturbances in the upper gastrointestinal series were studied in a separate radiologic material of 69 symptomatic patients with cholecystectomy in their history. Both series were compared with matched unoperated controls. The frequency of active gastric ulcers and ulcer scars was observed to be increased and that of active duodenal ulcers and ulcer scars decreased among the cholecystectomized patients in the autopsy series (p = 0.01 in both cases). This difference was not as pronounced when only active ulcers were included, but for active duodenal ulcers the difference was still significant (p = 0.04). One-fourth of the cholecystectomized patients but none of the controls had severe adhesions of the duodenum. In the autopsy series the thickness of the pyloric muscle and in the radiologic series the length of the radiologic pyloric canal were thickened/lengthened in an average of 26%/11% in patients who had undergone cholecystectomy (p less than 0.001 and p less than 0.10, respectively). The lengthening of the pyloric canal was in significant positive correlation with the motility disturbance/adhesion score of the upper gastrointestinal series.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Chronic gastritis in cholecystectomized patients.

Duodenogastric reflux is considered to be a possible cause of chronic gastritis. This reflux, however, is reported to be common after cholecystectomy. In the present investigation we have studied the possible relation between chronic gastritis and prior cholecystectomy in 106 symptomatic outpatients with prior cholecystectomy and in 131 controls without cholecystectomy. We surveyed their endoscopic biopsy specimens from antral, body, and esophageal mucosa. We found that the mean score and prevalence of chronic antral and body gastritis in cholecystectomized patients was the same as or slightly lower than that in controls. The mean progression of gastritis, when compared with the progression of gastritis in the general population, was slightly slower than expected in the cholecystectomized patients. This slow progression was seen in body gastritis in cholecystectomized patients with a coexisting esophagitis. We conclude that there is no positive correlation between chronic gastritis and prior cholecystectomy. In contrast, this correlation may be negative, especially in patients with esophagitis, in whom an association of the postcholecystectomy state and a possible duodenogastric reflux with normal, nongastritic and nonatrophic body mucosa may facilitate mechanisms favoring the pathogenesis of esophagitis.

Adult↗
PubMed1987

Gastric ulcer and gastritis: results of short-term follow-up examinations.

A hundred and one cases of gastric ulcer were examined in Poland by direct-vision endoscopic biopsy obtained from the antrum, angulus and body far outside the ulcer area, and from the edge of the ulcer. A simple mean score of gastritic changes and of intestinal metaplasia (IM) was calculated for each area, as also a mean score of IM for the mucosa around the ulcer. Two re-examinations were performed, one on average 2 months and the other on average 4.5 years, after the first examination. On the whole, gastritic changes and IM behaved as expected from earlier studies. The most striking finding was the high mean score of the angular mucosa in the case of more proximally situated ulcers. This angular peak was present at all examinations and both in patients healed during the follow-up and those in whom the disease remained active. A corresponding peak of gastritic changes and IM at the angulus was not found in more comprehensive Finnish control material, but was present in another smaller outpatient series, although the differences between the angulus and surrounding tissues were insignificant. At the first examination the mean scores of gastritis and of IM outside and around the ulcer were higher in patients with proximal ulcers in whom the ulcer healed during the observation period than in those, in whom it remained active. This difference was found at the first and at all subsequent examinations, and some of the differences were statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1987

The effect of ethanol with a meal on the mucosa of the stomach and duodenal bulb.

The effect of ethanol together with a meal on the mucosa of the stomach and duodenal bulb was studied in nine healthy volunteers. The pre-study gastroscopy was performed after an overnight fast. Two to four weeks later the volunteers drank 72-136 g (mean 111.2 +/- 18.3 SD) alcohol together with a meal. They underwent endoscopy again on the following morning. The endoscopic and histological changes were evaluated by scoring the lesions (0-4). Alcohol caused slight to moderate endoscopically detected changes in the stomach of seven volunteers, the difference being statistically almost significant (p congruent to 0.05) in the case of haemorrhagic lesions. In two subjects slight hyperaemia was seen in the duodenal bulb. The histological study did not reveal significant changes after alcohol drinking. The bile acid concentrations of the gastric juice did not change after drinking. It is concluded that ethanol with a meal causes only slight changes in the mucosa of the stomach, haemorrhagic ones being the most prominent.

Adult↗
PubMed1987

Classification principles and genetics of chronic gastritis.

Two family samples, (i) a sample considered to represent the population at large (431 subjects) and (ii) a sample of first-degree relatives of index subjects (IS) with overt pernicious anaemia (183 subjects) were analyzed in order to evaluate the onset and course of chronic gastritis (CG) and the pathogenetic factors involved with special reference to the effects of genetic variation. The analysis was based on data obtained from two generations: first generation (sibs of the IS) and second (children of the IS). Formulae derived from Poisson process were used for age-correction of the gastritic changes. Otherwise, conventional statistical methods were used in the genetic analysis and the calculation of prevalences of CG. This approach enabled us to achieve a classification of gastritis into more specific subgroups and to evaluate the natural course of the disease. The progression of gastritis in the second generation (children; mean age 35 years) was roughly similar in antrum and body, indicating that gastritis starts as a diffuse process affecting both areas of the stomach to a rather similar degree. The start of CG and its progression is at least to some degree influenced by genetic factors and probably regulated by the male sex. Thus nearly all children of male IS's with a non-atrophic mucosa (normal mucosa or superficial gastritis) showed a normal mucosa suggesting the existence of a particular sex-bound, genetic mechanisms. These mechanisms may prevent or delay the progression of gastritis up to middle age, when a change in dynamics occurs leading to formation of more specific subtypes of CG. In the first generation (mean age 60 years) CG dispersed into more specific subtypes (corresponding to types A and B of Strickland and McKay and type AB of Glass) and to more advanced stages, which were connected with a higher than expected prevalence of advanced stages also in the relatives. The families of IS's with type A atrophic gastritis (AG) (severe AG in the body but no AG in antrum), type B (AG in antrum but no AG in body) and type AB AG (AG in both antrum and body) showed typical dynamic patterns of the age-specific prevalences of AG. Genetic calculations showed that the type A of AG found in pernicious anaemia patients and their relatives is inherited by a simple dominant gene, while this type of inheritance is statistically unlikely in the type B of AG. The type B, on the other hand, exhibited characteristics that indicate a recessive Mendelian inheritance.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗