Inflammation
Questions Received:
What are prostaglandins? How are they involved in inflammation?
What is C Reactive Protein and what relevance does it have to clinical conditions?
What are (3) tests that can be used to confirm that someone has an acute inflammatory response?
Responses:
7th May 1999
Gastritis is inflammation of the gastric mucosa which can be either acute or chronic.
Acute gastritis can be caused by:
Drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs: Indomethacin, Phenylbutazone, Aspirin) and corticosteroids (e.g Prednisolone - the risk with steroids may be reduced when enteric coated or soluble preparations are used, although the British National Formulary 1996 states that the benefits of their use are "speculative only"). Both the non-steroidal and steroidal preparations inhibit the synthesis of prostaglandins and this results in an increase in gastric acid secretion
Alcohol
Excess coffee consumption, particularly strong coffee
Highly spiced food
Pathogenic organisms, e.g. Salmonella, Staphylococcus
Cigarette smoking
Stress
Chronic gastritis can develop as a result of long standing irritation from the factors listed above for acute gastritis. In addition it can be idiopathic (no known cause) or or linked with aging - it is uncommon below the age of 50.
Reference
British National Formulary (BNF) Number 32 September 1996. Chapter 6 - Drugs used in the treatment of disorders of the Endocrine System. Disadvantages of Corticosteroids p. 300. A joint publication of the British Medical Association and the Royal Pharmaceutical Society of Great Britain.
What is C Reactive Protein and what relevance does it have to clinical conditions?
16th October 1999
The concentration of a number of plasma proteins increases after tissue injury, whether it is caused by bacterial infection, malignant neoplasia or surgical procedures. This is known as the acute-phase response and is a non-specific indicator of an inflammatory process. The plasma proteins are collectively termed acute-phase proteins. Their role is to help restore homeostasis. C-reactive protein (CRP) is a member of the acute-phase protein family, and is useful clinically because it is one of the best non-specific biochemical indicators of tissue damage, and therefore disease processes.
C-reactive protein is so-called because of its ability to bind to the C protein of pneumococci. When C-reactive protein and other complement proteins bind to bacteria it becomes easier for phagocytic cells such as macrophages to recognise, take in and destroy the bacteria. This defensive process of coating bacteria and other infectious organisms with protein is known as opsonisation.
Careful measurement of CRP levels over a period of time can be very useful in coming to a diagnosis, assessing the effectiveness of treatment, and determining the patient’s prognosis. Levels of C-reactive protein give a better insight into the progress of inflammation than the erythrocyte sedimentation test due to the more rapid kinetics (van Leeuwen and van Rijswijk, 1994). Kits are available now which allow the test for C-reactive protein to be carried out on a blood sample accurately within minutes (Pedrazzi, 1998).
References
Gabay, C., and Kushner, I. (1999) Acute-phase proteins and other systemic responses to inflammation. New England Journal of Medicine, 340(6), 448-454 (Feb 11).
Pedrazzi, A.H. (1998) Acute phase proteins: clinical and laboratory diagnosis. A review. Ann Pharm Fr, 56(3), 108-114.
van Leeuwen, M.A., and van Rijswijk, M.H. (1994) Acute phase proteins in the monitoring of inflammatory disorders. Baillieres Clinical Rheumatology, 8(3), 531-552 (Aug).
What are (3) tests that can be used to confirm that someone has an acute inflammatory response?
11th February 2000
There are several types of test that can be used to confirm an acute inflammatory process:
(1) Blood Tests - A differential white blood cell (leucocyte) count is made to establish whether a particular sub-group of white cells - neutrophils, eosinophils, basophils, monocytes or lymphocytes - has increased. The erythrocyte sedimentation rate (ESR) can also give information about the presence of inflammation.
(2) Culture and sensitivity tests on urine, stool and sputum specimens.
(3) Body temperature: most inflammatory conditions provoke an elevation in the person's temperature. This is particularly so in bacterial infections and is due to the release of pyrogens by the bacteria. Pyrogens act on the hypothalamus in the brain and alter the temperature set point. Monitoring a person's peripheral temperature is an important procedure carried out by nurses and the temperature chart conveys useful information about the progress of an inflammatory process.