To evaluate if the infection with strains of cytotoxin-associated gene A (CagA)-positive Helicobacter pylori is associated with either peptic ulcer and gastric atrophy or intestinal metaplasia in the elderly, we studied 71 H. pylori-positive patients older than 62 years old (34 men, 37 women; mean age, 77.5 years; range, 62-89 years) affected with gastric ulcer (GU) (n = 10), duodenal ulcer (DU) n = 22), or chronic gastritis (CG) (n = 39). H. pylori infection was documented by means of gastric histology, rapid urease test, and polymerase chain reaction (PCR) assay performed on gastric biopsies using two sets of primers: one for the ureC gene specific for H. pylori, and the second specific for the CagA gene. H. pylori-CagA positivity was significantly more common in patients with GU (9 of 10, 90%) than with DU (11 of 22, 50%; p < 0.05) or CG (17 of 39, 43.5%; p = 0.01). Gastric atrophy and intestinal metaplasia were significantly more common in CagA-positive patients than in CagA-negative patients (gastric atrophy: 40.54% vs 11.76, p = 0.007; intestinal metaplasia: 40.54% vs 14.70%, p = 0.01). No difference in prevalence of gastric atrophy and intestinal metaplasia was found in patients divided according to pathology (GU, DU, or CG). Logistic regression demonstrated that gastric atrophy and intestinal metaplasia were independent factors significantly associated with CagA-positivity (gastric atrophy: odds ratio = 4.53, 95% confidence interval 1.25-16.4; intestinal metaplasia: odds ratio = 3.44, 95% confidence interval 1.01-11.7). Our findings help to confirm the hypothesis that an infection with CagA-positive H. pylori strains may be catalytic in inducing gastric changes which can evolve into malignancies.
Introduction: Assessing the severity of patients presenting in the Emergency Department (ED) with ACPE is crucial to decide intensity of treatment and site of care. The 3CPO Trialists elaborated a Score based on presenting characteristic to predict 7-day mortality. Aim: To validate the 3CPO-score in a prospective cohort of ACPE patients. Methods: A multicentric, prospective,web-based,observational study was performed in 13 Italian ED. The 3CPO score was computed as follows: 0 to 2 points according to age; 0 to 3 points according to Systolic Blood pressure; 0 to 2 points according to the ability to obey to commands. Results: From May 2009 to October 2010, 240 patients were analyzed.Mean age was 80 years (SD±11 years), 117 male (48%). Overall 7-day mortality was 7% (17/240). Mortality according to the Score classes is shown in table 1. The result of the ROC analysis is depicted in Figure 1: the AUC was 0.75; however,intermediate values of the score did not reliability predict mortality in our population. Conclusion: In our cohort of patients, the 3CPO score yielded unsatisfactory results. We hypothize that this may depend on the different characteristics of our population and/or the different treatment; further studies are needed to confirm the applicability of the score in other populations.
A 5 years old boy affected with Glycogen Storage Disease type Ia (GSD-Ia) with previous optimal metabolic control developed severe erratic hypoglycemic episodes during continuous nocturnal gastric drip-feeding (CNGDF) administered by nasogastric tube. The episodes of hypoglycemia were not related to pump failure or human errors or wrong position of the tube in the gastrointestinal tract. Hyperinsulinism was also considered in this patient but it was excluded mainly because hypoglycemia was only nocturnal. Moreover, hypoglycemic episodes disappeared when CNGDF was stopped and he was fed with normal meals. The fact that hypoglycemia resolved after stopping CNGDF when nocturnal meals were introduced led us to hypothesize that CNGDF rich with simple carbohydrates might have been the cause of a sort of dumping-like syndrome. Dumping syndrome (DS) develops when a large amount of carbohydrate reaches the small intestine due to rapid gastric emptying (Tack et al. 2009; Hejazi et al. 2010). We suppose that CNGDF induced a disturbance of gastric motility with a gastric accumulation of fluids at a certain time of the night followed by a rapid voiding of the stomach leading to DS.
