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Helicobacter pylori eradication is superior to ulcer healing with or without maintenance therapy to prevent further ulcer haemorrhage.

BACKGROUND: Helicobacter pylori eradication decreases ulcer recurrence and should prevent recurrent ulcer haemorrhage. AIM: By meta-analysis, to compare treatment of H. pylori infection with other approaches to prevent recurrent ulcer haemorrhage and, by cost minimization analysis, to determine the least costly strategy. METHODS: We searched for randomized, controlled trials comparing treatment of H. pylori infection with ulcer healing alone or with maintenance therapy in preventing recurrent ulcer haemorrhage. We calculated the relative and absolute risk reductions and numbers needed to treat. RESULTS: Treatment of H. pylori infection decreased recurrent bleeding by 17% (numbers needed to treat=6) compared with ulcer healing treatment alone. Compared with ulcer healing treatment followed by maintenance therapy, recurrent bleeding was decreased by 4% (numbers needed to treat=25). Decision model-based cost minimization analysis demonstrated that treatment of H. pylori infection was the least costly strategy unless the incidence of complicated recurrences after treatment was over 6%, or the cost of confirming eradication was over $741. CONCLUSIONS: Treatment of H. pylori infection is superior to ulcer healing treatment with or without maintenance therapy in preventing recurrent ulcer haemorrhage. All patients with ulcer bleeding should be tested for H. pylori infection and appropriately treated if positive.

Anti-Bacterial Agents↗

Comparison of mortality from peptic ulcer bleed between patients with or without peptic ulcer antecedents.

We studied mortality related to peptic ulcer bleed in a well defined cohort of patients in the month after the episode of peptic ulcer bleed. Our objective was to assess the contribution of peptic ulcer antecedents and other predictive factors on the risk of dying. The study cohort comprised 1,020 patients hospitalized for an episode of peptic ulcer bleed between January 1991 and March 1994 and identified in the General Practice Research Database in the United Kingdom. Six hundred twenty-three patients had no prior episode of peptic ulcer disease, and 384 had peptic ulcer antecedents; for 13 patients, information was not available. Forty-five patients died (mortality rate = 4.4 per 100 person-months; 95% confidence interval = 3.3-5.9) within 1 month of the peptic ulcer bleed. Patients with no peptic ulcer antecedent faced a greater risk of dying than patients with antecedents (relative risk = 3.0; 95% confidence interval = 1.2-7.1). Elderly patients, those undergoing surgery, and current users of acid-suppressing drugs or nonsteroidal antiinflammatory drugs all had an increased mortality risk. Patients presenting with their first-ever episode of peptic ulcer bleed have a higher case fatality rate than those with previous episodes of peptic ulcer.

Adult↗

Peptic ulcer in the elderly--a double-blind, short-term study comparing nizatidine 300 mg with ranitidine 300 mg. GISU (Interdisciplinary Ulcer Study Group).

UNLABELLED: This was a randomized, double-blind, multicentre, short-term study comparing ranitidine and nizatidine at the standard dosages of 300 mg at bedtime. In 49 centres in Italy, all peptic ulcer patients aged over 65 years and with endoscopically documented acute disease were considered eligible for the study. Clinical check-ups were repeated every 3 weeks, while the endoscopic and biochemical assessments were scheduled at 6 and (in unhealed patients) 12 weeks. STATISTICS: chi-squared test, Fisher's exact test, Student t-test for unpaired data. The study included 170 duodenal ulcer and 75 gastric ulcer patients. Of these, 83/170 duodenal ulcer and 38/75 gastric ulcer patients were treated with nizatidine 300 mg and the remainder with ranitidine 300 mg. The groups were well-matched for common clinical data. Eight patients dropped out. Healing rates at 6 and 12 weeks were 81.9% and 91.5% for nizatidine-treated duodenal ulcer patients versus 78.1% and 94.2% for ranitidine-treated duodenal ulcer cases (P: N.S.); 6 and 12-week healing rates were 76.3% and 89.5% for nizatidine-treated gastric ulcer patients versus 67.6% and 83.8% for ranitidine-treated gastric ulcer patients (P: N.S.). No slow healing risk factors were found. Only minor adverse events were registered. IN CONCLUSION: ranitidine 300 mg and nizatidine 300 mg both proved effective and safe in the treatment of acute peptic ulceration in the elderly.

Aged↗

[Effects of FRG-8813, a new-type histamine H2-receptor antagonist, on the healing of gastric and duodenal ulcer in rats and spontaneously ulcerative mice].

We examined the anti-ulcer effects of FRG-8813, a new-type histamine H2-receptor antagonist, in chronic ulcer models of rats and mice (W/WV). FRG-8813, given orally twice a day for 7 days, accelerated the healing of gastric or duodenal ulcer induced by acetic acid injection or application at the non-antisecretory doses (0.3 approximately 3 mg/kg). Administration of FRG-8813 to rats with ulcers increased the amounts of mucus in the gastric mucosa. These actions of FRG-8813 were more potent than those of famotidine or cimetidine. In W/WV mice, several ulcers spontaneously developed on gastric mucosa during the 8 weeks after the birth. The ulcers were aggravated by several unknown factors after the ulcer generation in W/WV mice. The aggravation of ulcers was inhibited by the 4-week administration of FRG-8813 with diet at the dose of 1 or 10 mg/kg/day, but was not inhibited by cimetidine at the dose of 100 mg/kg/day. From these results, we suggest that FRG-8813 is able to accelerate the healing of ulcers by antisecretory plus increasing actions on the integrity of the gastric mucosal defense mechanisms; therefore FRG-8813 is expected to be a useful drug for the treatment of gastric or duodenal ulcers in humans.

Acetamides↗

Anti-ulcer effects of 4'-(2-carboxyetyl) phenyl trans-4-aminomethyl cyclohexanecarboxylate hydrochloride (cetraxate) on various experimental gastric ulcers in rats.

Anti-ulcer effects of cetraxate, a new compound possessing anti-plasmin, anti-casein and anti-trypsin actions were investigated by using experimental gastric ulcer models in rats. Cetraxate, 300 mg/kg p.o. showed significant inhibitory effects of 65.3%, 70.0%, 30.2%, and 67.1% against aucte types of ulcers producing by aspirin, phenylbutazone, indomethacin, and pyloric ligature (Shay's ulcer), respectively. These effects were greater than those obtained by gefarnate and aluminum sucrose sulfate may be mainly attributed to the protecting action of this drug on gastric mucosa. Ctraxate further revealed remarkable inhibitory effects on chronic types of ulcers produced by acetic acid, clamping, and clamping-cortisone. In acetic acid ulcer in particular, cetraxate was found to have a dose-dependent inhibitory effect at doses over 50 mg/kg. Of test drugs including L-glutamine and methylmethionine sulfonium chloride, cetraxate showed the most remarkable inhibitory effect on beta-glucuronidase activity in ulcer tissue of these three types of ulcers. These findings suggest that cetraxate may prevent the connective tissue in the ulcer location from decomposition due to lysosomal enzymes such as beta-glucuronidase, thereby accelerating the recovery from ulcer.

Acetates↗

Gastric acid secretion in patients with prepyloric ulcer and with combined gastric and duodenal ulcer.

The gastric acid secretion during stimulation with histamine given via a continuous intravenous infusion (i.e. during steady state conditions) was studied in 13 patients with prepyloric ulcers and in 21 patients with combined gastric and duodenal ulcers. The rate of volume secretion, the acidity and the acid output were analysed separately. The results were compared with earlier studies of patients with gastric ulcer and duodenal ulcer. Starting from the secretory pattern these four groups of ulcer were characterized. Gastric ulcers thus show hypoacidity. The pyloric ulcers do not differ from a normal material. The combined gastric and duodenal ulcers and the duodenal ulcers show hypersecretion, most pronounced in duodenal ulcers.

Adult↗

[Comparison of the effectiveness and cost of treatment with humid environment as compared to traditional cure. Clinical trial on primary care patients with venous leg ulcers and pressure ulcers].

INTRODUCTION: The discovery of moist environment dressings as alternatives to the traditional treatments based on exposing wounds to air, opened new expectations for the care and treatment of chronic wounds. Over the years, these expectations have led to the availability of new moist environment dressings which have made it possible to improve the care provided to patients suffering this kind of wounds, as well as providing important reasons to weigh in terms of cost-benefit-effectiveness at the time of selecting which type of treatment should be employed. The lack of comparative analysis among traditional treatments and moist environment treatments for chronic wounds among patients receiving primary health care led the authors to perform an analysis comparing these aforementioned options of treatment on patients suffering venous leg ulcers or pressure ulcers. PATIENTS, MATERIALS AND METHODS: The authors designed a Randomized Clinical Trial involving patients receiving ambulatory care in order to compare the effectiveness and cost-benefit of traditional versus moist environment dressing during the treatment of patients suffering stage II or III pressure ulcers or venous leg ulcers. In this trial, variables related to effectiveness of both treatments, as well as their costs were analyzed. MAIN RESULTS: 70 wounds were included in this Randomized Clinical Trial, 41 were venous leg ulcers of which 21 received a moist environment treatment while 20 received traditional cure, the other 29 wounds were pressure ulcers of which 15 received moist environment dressings treatment and 14 received traditional dressings. No statistically significant differences were found among the defining variables for these lesions in either group under treatment. In the venous leg ulcer study group, the authors conclusions were an average of 18.13 days, 16.33 treatment sessions and a cost of 10,616 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 18.22 days, 4.54 treatment sessions and a cost of 2409 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with moist environment dressings. In the pressure ulcers study group, the authors conclusions were an average of 12.18 days, 12.1 treatment sessions and a cost of 15,490 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with traditional treatment compared to an average of 7.12 days, 1.86 treatment sessions and a cost of 2610 pesetas to heal one square centimeter of the initial surface area of a wound on patients treated with moist environment dressings. COMMENTS: The results of this randomized clinical trial demosntrated that the moist environment treatment group was more effective and had a better cost-benefit ratio than the traditional treatment group in the treatment of pressure ulcers and venous leg ulcers on patients cared for by nursing personnel in primary health care centers all of which agrees with publications consulted by authors.

Chronic Disease↗

Indomethacin treatment during initial period of acetic acid-induced rat gastric ulcer healing promotes persistent polymorphonuclear cell-infiltration and increases future ulcer recurrence. Possible mediation of prostaglandins.

The study was performed to examine whether indomethacin administered during the initial period of acetic acid-induced gastric ulcer healing affects future ulcer recurrence. Gastric ulcers were produced in rats by subserosal injection of acetic acid. Indomethacin (1 mg/kg/day, orally) administered either alone or concomitant with ornoprostil (50 micrograms/kg/day, orally) was started on the fourth day and continued for 56 days. In rats whose ulcer healed at the 90th day after production of ulcer, endoscopy was done every 30 days to examine recurrence of ulcer. Gastric specimens were obtained 10, 30, 60, 90, and 240 days after ulcer production for histology, to quantitate the height of regenerated mucosa, thickness of fibrous tissue, degree of polymorphonuclear cell infiltration, and PAS-positive cells. Cumulative ulcer recurrence rate was significantly higher in rats initially treated with indomethacin than in controls. Increased polymorphonuclear cell infiltration was the major histologic abnormality persisting after cessation of indomethacin. Ornoprostil reversed these abnormalities caused by indomethacin. In conclusion, the administration of indomethacin during the initial period of the ulcer healing promoted persistent polymorphonuclear cell infiltration and increased ulcer recurrence rates, possibly via a prostaglandin-dependent mechanism.

Alprostadil↗

Endoscopic therapy with absolute ethanol for postoperative recurrent ulcers in intestinal Behçet's disease, and simple ulcers.

BACKGROUND: When examined macroscopically and histologically, there are no differences between "simple" intestinal ulcers and intestinal ulcers of Behçet's disease. The postoperative recurrence of intestinal Behçet's disease and simple ulcers was frequently. Medical treatment for postoperative recurrent ulcers is palliative, and the patient often requires surgery. We studied about an effect of absolute ethanol spraying via endoscopy for the ulcers. METHOD: The postoperative rate of recurrence was 56% (9/16). Commonly the ulcer recurred around the anastomotic region. We performed spraying for recurrent ulcers with absolute ethanol via endoscope in four patients. RESULTS: This therapy was effective for the recurrent ulcer in the 4 patients. In this study, the patients who were monitored and treated by the spraying of ethanol did not require further surgery. CONCLUSIONS: This therapy should performed for recurrent ulceration in cases of simple ulcer and intestinal Behçet's disease.

Administration, Topical↗

Ten-year follow-up of a prospective, randomized trial of selective proximal vagotomy with ulcer excision and partial gastrectomy with gastroduodenostomy for treating corporeal gastric ulcer.

Between 1975 and 1980, 30 patients with type I corporeal gastric ulcer were randomly allocated to undergo selective proximal vagotomy with ulcer excision or partial gastrectomy with gastroduodenostomy. Sixteen patients underwent selective proximal vagotomy (1 was excluded from the follow-up since microscopic examination of the excised ulcer revealed an early gastric cancer) and 14 underwent partial gastrectomy. No significant differences in the clinical results were found 3 years after surgery. During a median follow-up of 10 years, ulcer recurred in 3 patients after selective proximal vagotomy and in 2 after partial gastrectomy. One patient in each group had recurrent ulcer without symptoms and received no treatment. Two selective proximal vagotomy patients and three partial gastrectomy patients had epigastric pain with or without ulcer. One patient with selective proximal vagotomy underwent a second operation because of epigastric pain and recurrent ulcer. Bowel habits remained unchanged in all but one patient in each group, and mild or moderate dumping was recorded for two patients in each group. Very good or good results (modified Visick scale) were recorded for 11 of 15 patients after selective proximal vagotomy and for 10 of 14 patients after partial gastrectomy. Except for one patient in each group who had moderate dumping, patients classified as Visick III or IV had no symptoms during treatment with antacids or H2-blockers, or had asymptomatic ulcers and needed no treatment. Selective proximal vagotomy reduced the median acid response to insulin hypoglycemia and to pentagastrin by 100% and 80%, respectively, for at least 3 to 5 years, and partial gastrectomy reduced the median acid response to pentagastrin by 97%. In our opinion, selective proximal vagotomy with ulcer excision is an alternative to partial gastrectomy for surgically treating type I gastric ulcer.

Duodenostomy↗

Selective cyclooxygenase-2 blocker delays healing of esophageal ulcers in rats and inhibits ulceration-triggered c-Met/hepatocyte growth factor receptor induction and extracellular signal-regulated kinase 2 activation.

Nonsteroidal anti-inflammatory drugs, both nonselective and cyclooxygenase-2 (COX-2) selective, delay gastric ulcer healing. Whether they affect esophageal ulcer healing remains unexplored. We studied the effects of the COX-2 selective inhibitor, celecoxib, on esophageal ulcer healing as well as on the cellular and molecular events involved in the healing process. Esophageal ulcers were induced in rats by focal application of acetic acid. Rats with esophageal ulcers were treated intragastrically with either celecoxib (10 mg/kg, once daily) or vehicle for 2 or 4 days. Esophageal ulceration triggered increases in: esophageal epithelial cell proliferation; expression of COX-2 (but not COX-1); hepatocyte growth factor (HGF) and its receptor, c-Met; and activation of extracellular signal-regulated kinase 2 (ERK2). Treatment with celecoxib significantly delayed esophageal ulcer healing and suppressed ulceration-triggered increases in esophageal epithelial cell proliferation, c-Met mRNA and protein expression, and ERK2 activity. In an ex vivo organ-culture system, exogenous HGF significantly increased ERK2 phosphorylation levels in esophageal mucosa. A structural analog of celecoxib, SC-236, completely prevented this effect. These findings indicate that celecoxib delays esophageal ulcer healing by reducing ulceration-induced esophageal epithelial cell proliferation. These actions are associated with, and likely mediated by, down-regulation of the HGF/c-Met-ERK2 signaling pathway.

Animals↗

Does Helicobacter pylori infection explain all socio-economic differences in peptic ulcer incidence? Genetic and psychosocial markers for incident peptic ulcer disease in a large cohort of Danish adults.

BACKGROUND: Peptic ulcer epidemiology has changed considerably within the past century. The aim of this study was to assess the 11-year cumulative incidence of peptic ulcer disease and examine the relationship between ulcer incidence and psychosocial and genetic factors. METHODS: A random sample of 2416 Danish adults with no history of peptic ulcer disease residing in Copenhagen County, Denmark, attended a population-based prospective cohort study in 1983 and 1994. All participants reported whether they had had an ulcer diagnosed within the observation period. Information on socio-economic factors, family history of peptic ulcer disease (PUD) and lifestyle practices was obtained from a questionnaire. Lewis blood group antigens were assessed from blood samples and Helicobacter pylori infection status was determined with an in-house IgG ELISA. RESULTS: The overall 11-year cumulative incidence proportion of PUD was 2.9% (95% CI (2.2; 3.6)), i.e. 1.6% (95% CI (1.1; 2.1)) for duodenal ulcer, and 1.3% (95% CI (0.8; 1.7)) for gastric ulcer. Poor socio-economic status increased the risk of PUD independently of H. pylori infection (odds ratio 2.7, 95% CI (1.1; 6.1)) and accounted for 17% of all ulcer cases. High physical activity at work increased the risk of PUD in people infected with H. pylori (odds ratio 2.6, 95% CI (0.8; 8.0)). Family history of PUD or Lewis blood group antigens did not relate to ulcer incidence. CONCLUSIONS: Poor socio-economic status is an important risk factor for PUD that exerts its effect independently of H. pylori infection. Strenuous work may increase the risk of PUD in people with H. pylori infection. Genetic factors do not influence the risk of PUD in Danish adults.

Adult↗

Most patients with active symptomatic duodenal ulcers fail to develop ulcer-type pain in response to gastroduodenal acidification.

The most frequent symptom of duodenal ulcer is epigastric pain. However, the pathogenesis of duodenal ulcer pain is not established, although it is often attributed to duodenal acidification. The purpose of this study was to determine whether or not gastroduodenal acidification with either 400 ml of pH 1 citric acid or pH 0.85 hydrochloric acid resulted in ulcer-type pain in patients with endoscopically documented active symptomatic duodenal ulcer under doubled-blind randomized conditions. Thirteen consecutive male duodenal ulcer patients with daytime and nocturnal epigastric pain were studied before beginning medical therapy; five with citric acid or sodium citrate at pH's 1, 3, and 7, and eight with hydrochloric acid at pH 0.85 and pH 7 sodium citrate. Ten normal subjects served as controls. Four of the five symptomatic duodenal ulcer patients failed to have pain with the pH 1 citric acid, while one developed pain. Five of the eight patients tested with 0.15 mM hydrochloric acid had no pain. Of the three who developed pain with hydrochloric acid, two had endoscopic evidence of esophagitis (one developed retrosternal pain and one both retrosternal and epigastric pain), and one had the sensation of epigastric "fullness" with both the pH 0.85 and pH 7 solutions. There were no significant differences (p greater than 0.1) between the responses of the duodenal ulcer and normal subjects nor within the duodenal ulcer group in response to the pH 0.85 or 1.0 solutions versus the pH 7 solution. In summary, gastric acidification equivalent to 80 mmol/hour failed to induce pain in most patients with active symptomatic duodenal ulcer. These observations suggest that duodenal ulcer pain is largely unrelated to duodenal acidification.

Adult↗

Wound classification is more important than site of ulceration in the outcome of diabetic foot ulcers.

The importance of wound classification and site of ulceration was evaluated in 314 consecutive diabetic patients with foot ulcers. The ulcers were classified as superficial (through the full thickness of the dermis; n = 150), deep (n = 50), osteomyelitis and/or abscess (n = 46), minor gangrene (n = 39) or major gangrene (n = 29). Wound healing was defined as intact skin for at least 6 months. In patients with superficial and deep ulcers, primary healing occurred in 88% and 78%, respectively, compared with 57% in those patient who developed an abscess and/or osteomyelitis. Only 2 out of 68 patients with gangrene healed (through mummification) without amputation. Patients with gangrene had lower ankle and toe blood pressure than patients with all other types of ulcers. There were only marginal differences in primary healing rate between different ulcer sites. The highest rate was seen in ulcers localized to the metatarsal heads (78%). Patients with multiple ulcers had the lowest primary healing rate (5%) compared with single ulcers at all sites. These differences were probably due to circulatory factors, since patients with multiple ulcers had lower distal perfusion pressures compared with all other groups.

Blood Pressure↗

Pinch grafting of leg ulcers. A retrospective study of 412 treated ulcers in 146 patients.

In a retrospective study of 412 leg ulcers in 146 patients treated with pinch grafting, with a mean duration of follow-up of 32 months (range 2-84), the overall healing rate was 38%. The healing rate was best in the vasculitic ulcers (56%), followed by venous ulcers (38%), arteriosclerotic ulcers (33%), mixed ulcers (33%) and "other ulcers" (20%). In the series as a whole, the mean duration of ulcer problems was 8 years, and that of the 412 ulcers treated 2.5 years; the mean recurrence rate was 28%, and the mean remission time 12.5 months. In the ulcers that were still healed at close of the study (comprising 27% (112/412) of the series), the remission time was > or = 26.6 months. Thus we consider pinch grafting to be a successful complement to conservative therapy in most types of ulcers.

Adult↗

Pressure ulcers in German nursing homes and acute care hospitals: prevalence, frequency, and ulcer characteristics.

In German healthcare facilities, research-based knowledge of pressure ulcers and their relation to patient characteristics is limited. To provide information for national and international comparison on pressure ulcers and related issues, two cross-sectional surveys were conducted among 21,574 German hospital patients and nursing home residents (147 institutions total) in 2002 and 2003. Prevalence and frequency rates of pressure ulcers in people at risk (Braden score of </=20) in different institution types were compared and descriptive data on severity, location, history, and origin of 3,857 wounds were analyzed to examine the relationship between age, body mass index, and Braden score and the frequency and severity of wounds. The studies found that among all persons at risk, pressure ulcer prevalence was 21.1% and that the number of pressure ulcers per person was higher in hospitals (1.91, 24.6%) than in nursing homes (1.42, 13.9%). In addition, in hospital patients and nursing home residents, 36.4% and 46.7% of wounds, respectively, were grade 2 severity and higher. In both types of institutions, the most common pressure ulcer locations were the lower back and the heels. In hospital patients, 51.4% of pressure ulcers were facility-acquired, compared to 60.2% in nursing homes. In hospital patients and nursing home residents, 7.4% and 29.7% of wounds, respectively, had existed for more than 3 months. The studies also found that persons with lower Braden scale scores had more ulcers and more severe pressure ulcers. Analysis of wounds in this large patient population provides more detailed information about the problem of pressure ulcers and should help improve prevention and treatment.

Age Distribution↗

Ten versus 28 days of cimetidine treatment for duodenal ulcer in Iran. Evidence for the need for risk-oriented individual treatment of ulcer patients.

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)

Animals↗

Gastric mucosal prostaglandin E2 levels in gastric non-ulcer and ulcer patients with chronic renal failure or without renal disease, and in healthy subjects.

Investigations were carried out as to whether a disturbance in the formation of cytoprotective prostaglandin (PG) E2 in gastric mucosa is implicated in chronic renal failure. PGE2-like immunoactivity in gastric mucosal specimens was measured in individuals with chronic renal failure (creatine clearance less than 10 ml/min), in individuals without any renal disease, presenting either gastric ulceration or not, as well as in healthy subjects. Regardless of the group of patients, compared to normal mucosa a significant decrease in PGE2-like immunoactivity (about 50-70%) was found in mucosa from atrophic gastritis but not from superficial gastritis. Whenever patients of the control group or patients with kidney disease suffered from ulcers, PGE2-like immunoactivity showed a decrease of about 60-70% in the non-ulcerated mucosa compared to that of non-ulcer subjects. Moreover, ulcer patients showed the same frequency of gastritis and similar mucosal PGE2-like immunoactivity in their non-ulcerated mucosa. Furthermore, compared to the tissue from the ulcer edge, independent of the presence of renal disease, a relative deficiency of PGE2-like immunoactivity of about 50-60% was detected in the non-ulcerated mucosa of ulcer patients. We therefore conclude that chronic renal failure probably has no impact on PGE2 formation in the gastric mucosa. All told, relative mucosal PGE2 deficiency in gastric ulcer disease seems not to be correlated with chronic renal failure.

Adult↗