Advertisement
Mayo Clinic Proceedings Home

Helicobacter pylori, Peptic Ulcer, and Cimetidine

      We read with interest the article by Fich and associates in the February 1990 issue of the Proceedings (pages 187 to 191). An interesting association between Helicobacter pylori (formerly called Campylobacter pylori) and gastritis or peptic ulcer diseases has been claimed by many authors.
      • Porro GB
      • Lazzaroni M
      Campylobacter pylori and ulcer recurrence (letter to the editor).
      • Drumm B
      • Sherman P
      • Cutz E
      • Karmali M
      Association of Campylobacter pylori on the gastric mucosa with antral gastritis in children.
      • Hornick RB
      Peptic ulcer disease: a bacterial infection? (editorial).
      • Warren JR
      Unidentified curved bacilli on gastric epithelium in active chronic gastritis (letter to the editor).
      • Marshall BJ
      Unidentified curved bacilli on gastric epithelium in active chronic gastritis (letter to the editor).
      • Price AB
      • Levi J
      • Dolby JM
      • Dunscombe PL
      • Smith A
      • Clark J
      • Stephenson ML
      Campylobacter pyloridis in peptic ulcer disease: microbiology, pathology, and scanning electron microscopy.
      Although we agree with Dooley and colleagues
      • Dooley CP
      • Cohen H
      • Fitzgibbons PL
      • Bauer M
      • Appleman MD
      • Perez-Perez GI
      • Blaser MJ
      Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons.
      that H. pylori infection may be of potential importance in the asymptomatic population, suggesting that the bacterium is a commensal of the stomach, we would like to ask Fich and colleagues whether H. pylori is an opportunistic pathogen in the gastroduodenal region, similar to Pneumocystis carinii in the lung areas.
      Because cimetidine, which is being widely used for the treatment of peptic ulcer disease, has been shown to enhance T-cell function,
      • Breuillard F
      • Szapiro E
      Cimetidine in acquired tolerance to dinitrochlorobenzene.
      we investigated whether this drug has any antibacterial effect through enhancement of humoral immunity. Cimetidine was diluted with brain-heart infusion broth (100 mg, 50 mg, 20 mg, 10 mg, and 5 mg/ml), and one drop of solution that contained a 10”
      • Warren JR
      Unidentified curved bacilli on gastric epithelium in active chronic gastritis (letter to the editor).
      dilution of H. pylori isolated from the gastric juice of a 14-year-old child with gastritis was added and cultured for 24 hours. Examination at 4, 8, and 24 hours showed that bacteria had grown in each tube; this result should naturally lead to the conclusion that cimetidine has no antibacterial effect on H. pylori.
      Subsequently, we investigated the effect of cimetidine on the phagocytic functions of the macrophages. Peritoneal macrophages were collected from mice by washing the peritoneal cavity with phosphate-buffered Ringer's solution. Macrophages were purified by Ficoll-Hypaque gradient centrifugation.
      • Boyum A
      Isolation of mononuclear cells and granulocytes from human blood.
      Bacteria and macrophages were mixed in a 50:1 ratio in phosphate-buffered Ringer's solution that contained 10 mg/ml of cimetidine and 10% heat-activated guinea pig serum and incubated at 37°C for 30 minutes. Phagocytosis was then quantitatively evaluated on Giemsa-stained specimens prepared by cytocentrifugation. At least 250 macrophages were scored for each sample. Statistical analysis revealed no difference between the cimetidine and control groups (P>0.05) (Table 1).
      Table 1Effect of Cimetidine on Bacteria and Phagocytic Function of Macrophages
      GroupMacrophages with associated bacteria (%)No. of bacteria 100 macrophages
      Cimetidine6.012.0
      Control8.010.0
      In summary, both groups of experiments revealed no evidence in support of antibacterial or phagocytosis-promoting effects of cimetidine.

      REFERENCES

        • Porro GB
        • Lazzaroni M
        Campylobacter pylori and ulcer recurrence (letter to the editor).
        Lancet. 1988; 1: 593
        • Drumm B
        • Sherman P
        • Cutz E
        • Karmali M
        Association of Campylobacter pylori on the gastric mucosa with antral gastritis in children.
        N Engl J Med. 1987; 316: 1557-1561
        • Hornick RB
        Peptic ulcer disease: a bacterial infection? (editorial).
        N Engl J Med. 1987; 316: 1598-1600
        • Warren JR
        Unidentified curved bacilli on gastric epithelium in active chronic gastritis (letter to the editor).
        Lancet. 1983; 1: 1273
        • Marshall BJ
        Unidentified curved bacilli on gastric epithelium in active chronic gastritis (letter to the editor).
        Lancet. 1983; 1: 1273-1275
        • Price AB
        • Levi J
        • Dolby JM
        • Dunscombe PL
        • Smith A
        • Clark J
        • Stephenson ML
        Campylobacter pyloridis in peptic ulcer disease: microbiology, pathology, and scanning electron microscopy.
        Gut. 1985; 26: 1183-1188
        • Dooley CP
        • Cohen H
        • Fitzgibbons PL
        • Bauer M
        • Appleman MD
        • Perez-Perez GI
        • Blaser MJ
        Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons.
        N Engl J Med. 1989; 321: 1562-1566
        • Breuillard F
        • Szapiro E
        Cimetidine in acquired tolerance to dinitrochlorobenzene.
        Lancet. 1978; 1: 726
        • Boyum A
        Isolation of mononuclear cells and granulocytes from human blood.
        Scand J Clin Lab Invest Suppl. 1968; 97: 77-89

      Linked Article