Seasonal changes in gastric mucosal factors associated with peptic ulcer bleeding

Abstract

A close association has been established between climate and peptic ulcer bleeding (PUB). The incidence of PUB in cold climates is significantly higher than that in hot climates. In this study, gastric mucosal damage and its barrier function (through associated barrier factors) in extreme climate conditions were examined to investigate the pathogenesis of PUB in extreme cold climates. Gastric juice and biopsy specimens were collected from 176 patients with peptic ulcer. Conventional hematoxylin and eosin staining was used to exclude malignant ulcers. Helicobacter pylori infections were detected by modified Giemsa staining. pH values of the gastric juice samples were obtained on-site by precise pH dipstick readings. The protein expression levels of heat shock protein (HSP) 70, occludin, nitric oxide synthase (NOS), epidermal growth factor (EGF) and EGF receptor (EGFR) in the gastric mucosa were detected by immunohistochemistry. No significant differences were identified between the high and low bleeding risk groups in the rates of H. pylori infection and the pH values of the gastric juices in the extreme hot or cold climates. Furthermore, no statistically significant differences were identified in the protein expression levels of occludin, NOS, EGF and EGFR between the high and low bleeding risk groups. In the extreme cold climate, the expression of HSP70 and the mucus thickness of the gastric antrum in the high bleeding risk group were significantly lower than those in the low bleeding risk group. The protein expression levels of occludin, HSP70, NOS and EGFR in the extreme cold climate were significantly lower than those in the extreme hot climate, whereas the gastric acid secretion was significantly higher in the extreme cold climate than that in the extreme hot climate. In conclusion, low expression of HSP70 in the gastric mucosa and reduced gastric mucus thickness may play key roles in the mechanism of PUB in extreme cold climates. The significant decrease in barrier factors and increase in damage in extreme cold climates may be associated with the seasonal pattern of peptic ulcers.

The role of the hypothalamic-pituitary-adrenal axis in modulating seasonal changes in immunity

“…Diminished barrier protection, crowding (70), and increased efficiency of respiratory droplet transmission (71) during the winter may contribute to enhanced RTI incidence. An association between compromised mucosal barrier function, due to a reduction in gastric mucosal factors, and the seasonal peak of peptic ulcer disease occurrence in winter has also been reported (156). Moreover, epidemiological studies on rheumatoid arthritis disease activity report that rainy and cold weather appear to increase joint pain and stiffness (1, 48, 95).…”

Evaluation of the cytoprotective effects of anti-ulcer agents in acid-alcohol induced gastric ulceration in wistar rats

“…Protection against mucosal injury includes tight intercellular junctions, mucus secretion and mucosal blood flow, cellular restitution, prostaglandin E 2. epithelial renewal. Drugs such as sucralfate, colloidal bismuth and aluminum containing antacids (Yuan et al, 2015).Gastric ulcers have long been rated as one of the most common diseases affecting humans and young people in particular (Saad et al, 2016).…”

Effects of Seasonal Variation on Upper Gastrointestinal System Bleeding in Emergency Department

“…In contrast to these findings found in our study, it has recently been suggested that cold climate conditions increase the incidence of bleeding especially due to peptic ulcer. Yuan et al, in their study, observed a decrease in barrier functions of gastric mucosa and an increase at mucosa damage in cold climate conditions, and they claimed that this increased the incidence of peptic ulcer bleeding (9). In many other studies, it has been claimed that the frequency of UGB increases because of the increase in the incidence of helicobacter pylori and NSAID usage in winter (5,7).…”