This study examined a possible aetiological agent, namely, Helicobacter pylori, in perforated peptic ulcer disease and its relationship to persisting ulcer. Twenty-nine patients with perforated peptic ulcer underwent simple closure of the perforation at laparotomy. A 13C urea breath test carried out on the eighth day after operation was positive in 24 patients. Fourteen of 17 patients who underwent upper gastrointestinal endoscopy 6 weeks after discharge from hospital had a positive 13C urea breath test. The biopsy urease test performed on mucosal samples taken at endoscopy was positive in 12 of these 14 patients, indicating continuing active infection with H. pylori. Seven patients with positive 13C urea breath and biopsy urease tests had persisting duodenal ulceration. None of the three patients with a negative 13C urea breath test had evidence of duodenal ulceration at endoscopy. The association between a high rate of duodenal ulcer persistence and a high incidence of H. pylori infection suggests that antibiotic therapy to eradicate this microorganism should be given to all patients with perforated peptic ulcer disease.

CD shows atypical features in adults, and physicians must include this disorder in the differential diagnosis of adults with iron deficiency or slight hypertransaminasemia. Increased awareness of the disease and extensive availability of accurate sero-logical tests will lead to improved diagnosis of this disorder, both in children and adults.

In Spain, the most frequent clinical presentation of CD is the classical form, mainly diagnosed during the first 2 years of life. The observed incidence of CD in Spanish children is much higher than the present CD incidence rates observed in other European countries.

Celiac disease (CD), an immune enteropathy caused by gluten-containing foods in genetically susceptible individuals, is usually diagnosed during childhood, but delayed diagnosis in adulthood is not uncommon (1 ). One-half of cases show atypical forms of the disease, e.g., irondeficient anemia unresponsive to iron or persistent hypertransaminasemia (2-4 ).Patients with CD often have high circulating concentrations of anti-endomysium antibodies (EMAs), the main disease marker (5 ), and anti-gliadin antibodies (AGAs), the most effective marker for children Ͻ3 years (6, 7 ). Tissue transglutaminase (tTG) has been identified as the autoantigen of CD (8 ).The first assays for tTG antibodies used antigen from guinea pigs (9 -15 ). Assays that used recombinant human tTg (rh-tTG) improved sensitivity and specificity (16 -21 ), but it is not well established in prospective studies whether the clinical effectiveness of rh-tTG is similar for children and adults.The aims of this study were (a) to evaluate the potential utility of rh-tTG IgA (rh-tTGA) compared with EMAs and AGAs for CD diagnosis in children and adults; (b) to analyze the concordance between rh-tTGA and small intestine biopsy (IB); and (c) to analyze the association of hypertransaminasemia and ferropenia with untreated CD.We prospectively selected 2570 patients with clinical suspicion of CD. Most patients (73.4%) were referred by the Pediatrics Department. From this cohort of patients we analyzed consecutively all patients fulfilling the inclusion and exclusion criteria. Inclusion criteria included histologic analysis of an IB and determination of serum markers for CD; the exclusion criterion was IgA deficiency. Both the IB and the immunologic markers were analyzed blindly and independently.The patients were classified into two groups. Group I consisted of 61 patients diagnosed with classic CD based on the results of the IB and obvious clinical and serologic response to a gluten-free diet. Group II contained 64 patients with clinical suspicion of CD but a normal IB and was considered the control group. The most common presentations in the control group were failure to thrive (29%) and gastrointestinal symptoms (27%).We also included 86 first-degree relatives of celiac patients, all asymptomatic. In this group we diagnosed six new cases of CD, who were then incorporated in group I.In our series 146 IBs were performed. Full-thickness jejunal biopsies were obtained by endoscopy or WatsonCrosby capsule (children). The histopathologic findings were classified according to internationally accepted criteria as normal mucosa, partial villous atrophy (slight, moderate, or severe), and subtotal villous atrophy (22 ). We considered all cases with at least a moderate villous atrophy as diseased, and biopsies showing slight atrophy or unspecific changes were considered as normal.rh-tTGA (expressed in the eukaryotic baculovirus system) was determined by enzyme immunoassay (Celikey; Pharmacia Diagnostics). The antibody concentration was expressed in arbitrary units (AU/mL)....

VacA and CagA serological responses were detected in pediatric patients: 44 and 56%, respectively, in peptic ulcer (PU) patients, 33.3 and 44.4% in active chronic gastritis (ACG) patients, and 23.2 and 39.2% in non-ACG patients. Higher seroprevalence to CagA؉VacA and to CagA؉VacA؉35-kDa antigen was found among PU patients. However, a low level of sensitivity and specificity was found for indirect detection of PU patients.