Showing papers in "Digestive Diseases and Sciences in 1984"
TL;DR: The findings raise the possibility that a previously unrecognized mycobacterium plays an etiologic role in at least some cases of Crohn's disease.
Abstract: A previously unrecognized Mycobacterium species was isolated from two patients with Crohn's disease. The organism is an acid-fast, mycobactin-dependent Mycobacterium that has characteristics which do not conform to any of the presently recognized species. It belongs to the Runyon group III mycobacteria and is most closely related to Mycobacterium paratuberculosis. Animal inoculation revealed pathogenicity for mice when injected intravenously or intraperitoneally, but not for rats, guinea pigs, rabbits, or chickens. The mice developed hepatic and splenic granulomas which contained numerous acid-fast mycobacteria. A 7-day-old goat which was inoculated orally with 50 mg of the organism developed both humoral and cell-mediated immunologic responses in two to three weeks and granulomatous disease of the distal small intestine, with noncaseating tuberculoid granulomas in five months. Acid-fast bacilli were not demonstrable in sections of the intestine, but a single organism was seen in each of two microgranulomas of the mesenteric lymph node. The Mycobacterium species was reisolated from the lymph node but not from intestine. Our findings raise the possibility that a Mycobacterium plays an etiologic role in at least some cases of Crohn's disease.
350 citations
TL;DR: Improvement in diarrhea was not associated with any change in stool weight but was associated with reductions in stool frequency, and incidence of urgency, which was the only symptom that was significantly more common in the success group, compared with the group who did not feel better on loperamide.
Abstract: Symptom scores, stool data, and the transit of a standard, solid meal were measured in 28 patients with irritable bowel syndrome (IBS) during baseline conditions and after five weeks of treatment with placebo and loperamide, given as a flexible dosage regime in the form of a double-blind, cross-over trial. All patients had undergone a comprehensive series of diagnostic investigations and had failed to respond to dietary supplementation with coarse wheat bran (10–30 g daily). Loperamide treatment accelerated gastric emptying, compared with placebo (1.2±0.1 vs 1.5±0.1 hr; P<0.001) and delayed both small bowel (6.2±0.3 vs 4.3±0.3 hr P<0.001) and whole gut transit (56±5 vs 42±4 hr; P<0.01). Eighteen patients said they felt better taking loperamide compared with placebo and, at follow up, 15 of these patients remained satisfied with the effects of the drug. Most symptoms improved significantly on placebo compared with the baseline period, but three of these [diarrhea (P<0.01), urgency (P<0.01) and borborygmi (P<0.05)] showed a further significant improvement on loperamide. Improvement in diarrhea was not associated with any change in stool weight but was associated with reductions in stool frequency (P<0.001), passage of unformed stools (P<0.01), and incidence of urgency (P<0.001). Urgency was the only symptom that was significantly more common in the success group, compared with the group who did not feel better on loperamide.
239 citations
TL;DR: An unclassifiedMycobacterium species has been isolated from two patients with Crohn's disease (CD), and although patients with positive PPD had elevated titers to this organism, the positive response of CD patients was not related to PPD responsiveness, area of involvement in the gut, nor to activity of the disease process.
Abstract: An unclassifiedMycobacterium species has been isolated from two patients with Crohn's disease (CD). Antibodies to the unclassified mycobacteria cross-reacted withMycobacterium paratuberculosis. Because of this cross-reactivity, an enzyme-linked immunosorbent assay (ELISA) was used to examine the sera of inflammatory bowel disease (IBD) patients, both CD (N=56), and ulcerative colitis (UC) (N=34), for antibodies toM. paratuberculosis, Mycobacterium kansasii, andMycobacterium tuberculosis. Controls consisted of healthy, PPD-negative individuals (N=67), and from PPD-positive patients (N=41). Eighteen resected CD patients were also examined. CD patients had a statistically significant increase in antibody titer (P=0.0003) toM. paratuberculosis compared to healthy controls. Although patients with positive PPD had elevated titers to this organism, the positive response of CD patients was not related to PPD responsiveness, area of involvement in the gut, nor to activity of the disease process.
224 citations
TL;DR: In Baltimore the age-adjusted rate for Crohn's disease has increased to exceed the ulcerative colitis rate for whites of both sexes and nonwhite females, and trends in age- adjusted rates for other areas are also discussed.
Abstract: Between 1960 and 1979, three studies were conducted in the Baltimore Standard Metropolitan Statistical Area to ascertain the incidence rates of first hospitalizations for ulcerative colitis and Crohn's disease. The age-adjusted rates per 100,000 population for the 1977-1979 survey for ulcerative colitis in white and nonwhite males and females were 2.92, 1.79, 1.29, and 2.90, respectively; the Crohn's disease rates were 3.39, 3.54, 1.29, and 4.08, respectively. In Baltimore the age-adjusted rate for Crohn's disease has increased to exceed the ulcerative colitis rate for whites of both sexes and nonwhite females. The ulcerative colitis and Crohn's disease rates for nonwhite males are similar. The rate for white males exceeds that for nonwhite males for both ulcerative colitis and Crohn's disease, but the converse is true for females. Females have higher rates than males for Crohn's disease in both color groups and for ulcerative colitis among nonwhites. White ulcerative colitis rates are higher for males than for females. From the first to the second surveys, the white male and female rates for ulcerative colitis converge with increasing male and decreasing female rates, but then both decline from the second to the third surveys. For Crohn's disease, the age-adjusted rates increased for whites of both sexes and nonwhite females from the first to second surveys. The Crohn's disease rates appeared to stabilize for whites of both sexes between the second and present surveys, but they increased for nonwhites of both sexes. Trends in age-adjusted rates for other areas are also discussed.
215 citations
TL;DR: Revue: synthese, transport, segregation et secretion d'enzymes, Activation zymogenique, Pancreatite aigue experimentale.
Abstract: Revue: synthese, transport, segregation et secretion d'enzymes. Activation zymogenique. Pancreatite aigue experimentale. Pancreatite chronique
152 citations
TL;DR: An unusual small intestinal tumor was found in a 61-year-old male who complained of intermittent right lower quadrant burning pain, tenesmus, and bloody diarrhea as discussed by the authors, the tumor was located intramurally in the distal jejunum with no involvement of the overlying mucosa.
Abstract: An unusual small intestinal tumor was found in a 61-year-old male who complained of intermittent right lower quadrant burning pain, tenesmus, and bloody diarrhea. On gross examination, the tumor was located intramurally in the distal jejunum with no involvement of the overlying mucosa. Histologic examination revealed two elements: a spindle cell component with characteristics reminiscent of a Schwann cell neoplasm, and nests of larger epithelioid-like cells almost undistinguishable from the Zellballen of nonchromaffin paragangliomas. The neoplasm originated within the intestinal wall without apparent mucosal origin. Ultrastructural studies revealed features recapitulating the normal enteric plexus structure and quite unlike those described in normal or neoplastic smooth muscle, Schwann or paraganglion cells. On this basis, this neoplasm is considered as a malignant enteric plexus tumor or a plexosarcoma.
136 citations
TL;DR: Investigation of the effect of painless intermittent rectal distension on the rate at which a standard meal passes through the stomach and small intestine indicated that events occurring in the rectum may influence the function of more proximal regions of the gut.
Abstract: The effect of painless intermittent rectal distension on the rate at which a standard meal passes through the stomach and small intestine was investigated in normal volunteers using noninvasive techniques. Rectal distension significantly retarded the entry of the head of the meal into the cecum and the emptying of the meal from the stomach, although it had no significant effect on basal gastric acid secretion. After administration of the H2-receptor antagonist, ranitidine, there was no significant effect of rectal distension on gastric emptying, but the delay in small bowel transit time induced by rectal distension remained. These data indicate that events occurring in the rectum may influence the function of more proximal regions of the gut.
117 citations
TL;DR: The mechanism by which omeprazole inhibits the development of acute ulcers and accelerates healing of preexisting ulcers appears to be mainly due to its potent and longlasting antisecretory activity.
Abstract: The effects of omeprazole, a proton pump inhibitor, on gastric secretion and gastric or duodenal ulcers or erosions in rats were studied. Omeprazole, given intraduodenally, dose-dependently inhibited the gastric secretion (volume, acid and pepsin output) of pylorus-ligated rats. The antisecretory activity of omeprazole at 100 mg/kg persisted for 14 hr after treatment. Acutely induced gastric ulcers or erosions such as Shay ulcers, water-immersion stress-, indomethacin-, aspirin-, or prednisolone-induced erosions were all markedly inhibited by oral or intraduodenal administration of 10–100 mg/kg of omeprazole. The development of duodenal ulcers and gastric erosions caused by mepirizole was also potently inhibited by omeprazole at 3–10 mg/kg given orally. Repeated administration of omeprazole, 200 mg/kg/day in two divided doses for 14 days, significantly accelerated the spontaneous healing of acetic acid-induced gastric ulcers. The mechanism by which omeprazole inhibits the development of acute ulcers and accelerates healing of preexisting ulcers appears to be mainly due to its potent and longlasting antisecretory activity. The antisecretory and antiulcer activities of omeprazole are equal to or exceed those of cimetidine, both in the maximum inhibitory response and ED50 values.
116 citations
TL;DR: Colonoscopy should be employed as an initial study in patients with chronic or mild acute rectal bleeding and the predictive value of a positive colonoscopic diagnosis was 90% in this population of patients with angiodysplasia.
Abstract: Angiodysplasia is a recently recognized important cause of lower intestinal bleeding in older patients. Although angiography is an established procedure for the diagnosis of angiodysplasia, colonoscopy is being used increasingly for evaluation of lower intestinal bleeding. In order to define the nature of bleeding due to angiodysplasia and the appropriate role of colonoscopy, 80 patients diagnosed by angiography, pathology, or colonoscopy were reviewed. Bleeding attributable to angiodysplasia varied from acute life-threatening hemorrhage to occult blood in stools. Thirteen patients with angiodysplasia had no bleeding and were identified incidentally by colonoscopy performed for other indications. Eighty-nine percent of the lesions were located in the right colon and there was a mean of 1.5 angiodysplastic lesions per patient. The sensitivity of colonoscopy compared to angiography and pathology was 68% overall and 81% when the colon was completely examined and lesions were located in the colon. The predictive value of a positive colonoscopic diagnosis was 90% in this population. Colonoscopy should be employed as an initial study in patients with chronic or mild acute rectal bleeding.
116 citations
TL;DR: Observations were made that increasing meal total caloric content significantly slowed solid food gastric emptying but did not overcome the enhancing effect of meal weight; and liquid emptying rates were uninfluenced by meal total kcal amount.
Abstract: This study was designed to assess the relative influence of meal weight and caloric content on gastric emptying of liquid and solid meals in man. A dual radioisotopic method which permits noninvasive and simultaneous measurement of liquid- and solid-phase emptying by external gamma camera techniques was employed. Nine healthy volunteer subjects ingested 50-, 300-, and 900-g lettuce and water meals adjusted to either 68, 208, or 633 kcal with added salad oil. The following observations were made: (1) absolute emptying rates (grams of solid food emptied from the stomach per minute) increased directly and significantly with meal weight; (2) increasing meal total caloric content significantly slowed solid food gastric emptying but did not overcome the enhancing effect of meal weight; and (3) liquid emptying rates were uninfluenced by meal total kcal amount.
107 citations
TL;DR: It was concluded that the mucosa in untreated celiac disease was more “leaky” than normal and polyethylene glycol 400 cannot be recommended as a suitable marker for permeability studies of the small intestine.
Abstract: Mannitol (molecular weight 182), lactulose (342), and polyethylene glycol 400 (range 242–550) absorption was studied in 25 controls, 22 untreated celiacs, and 13 treated celiacs. Untreated celiacs absorbed less mannitol and more lactulose than controls. Absorption of higher as well as lower molecular-weight polyethylene glycols was reduced in untreated celiac disease. Absorption returned towards normal on treatment. Polyethylene glycol and lactulose absorption was enhanced by administering them in a hypertonic solution. Polyethylene glycol 400 but not lactulose or mannitol was lipid solublein vitro. It was concluded that the mucosa in untreated celiac disease was more “leaky” than normal. Polyethylene glycol 400 absorption data suggested that its absorption may largely be determined by its lipid solubility and was decreased in celiac disease because of the reduced surface area of the small intestine. Polyethylene glycol 400 cannot be recommended as a suitable marker for permeability studies of the small intestine.
TL;DR: In a single-dose acute study, the authors compared the effects of a new oral calcium blocker, diltiazem (90, 120, 150 mg) with placebo in five volunteers and 10 patients with chest pain/dysphagia and high amplitude peristaltic contractions in the distal esophagus-nutcracker esophagagus.
Abstract: Animal studies have shown that calcium blocking drugs decrease lower esophageal sphincter pressure and inhibit peristaltic amplitude and duration. In a single-dose acute study, we compared the effects of a new oral calcium blocker, diltiazem (90, 120, 150 mg) with placebo in five volunteers and 10 patients with chest pain/dysphagia and high amplitude peristaltic contractions in the distal esophagus-nutcracker esophagus. In volunteers, diltiazem had no effect on esophageal contractions when compared to baseline values or placebo. In contrast, most doses of diltiazem significantly (<0.05) decreased amplitude and duration of peristaltic contractions in patients with nutcracker esophagus. Despite adequate blood levels, interstudy analysis was not statistically significant because placebo also decreased these parameters. During an eight-week open-labeled study, diltiazem 90 mg QID significantly (P<0.01) improved symptoms of chest pain and dysphagia. Side effects were minimal. Although oral diltiazem has minimal effect on baseline esophageal contractions our chronic study suggests it may modify transient increases in neuromuscular tone associated with esophageal chest pain. These observations warrant further placebo-controlled studies.
TL;DR: It is concluded that SB is the most appropriate way to evaluate histologic changes related to reflux injury and that this method is mandatory in symptomatic patients with minimal endoscopic evidence of esophagitis.
Abstract: Controversy exists regarding the appropriate method for biopsy confirmation of esophageal reflux injury. We have compared endoscopic pinch biopsy (PB) with endoscopicallly directed Rubin tube suction biopsy (SB) in 40 patients with symptomatic gastroesophageal reflux disease (GERD). Utilizing a plastic tube attached alongside the endoscope, SB at specific sites in the esophagus can be easily obtained. Suction biopsy was rated superior to PB for adequacy of tissue, ability to make an interpretation, and certainty in diagnosis. These differences were most pronounced in patients with endoscopic grades 0 and 1+ esophagitis in which 59% of PBs were uninterpretable compared to 23% of SBs. The passage of the Rubin tube was easily done and could be performed repeatedly. Six of 40 patients (15%) developed substernal chest discomfort in the 24 hr following SB. We conclude that SB is the most appropriate way to evaluate histologic changes related to reflux injury and that this method is mandatory in symptomatic patients with minimal endoscopic evidence of esophagitis (0−1+).
TL;DR: In awake, normal subjects the rate of spontaneous swallows is influenced directly by salivary flow, particularly oral lozenges, which merit investigation as a potentially useful ancillary treatment for the relief of heartburn.
Abstract: Recent studies indicate that swallow-induced, primary peristalsis is a major determinant of normal esophageal acid clearance. However, factors that regulate the rate of spontaneous swallowing in normal subjects are incompletely understood. We postulated that the rate of salivary flow influences the rate of spontaneous swallows. To test this hypothesis, we did a total of 60 studies measuring salivary flow or the rate of spontaneous swallowing in 10 healthy volunteers, age 10–30 years. Saliva was collected by expectoration. Swallow rate was recorded by a small, transnasal catheter stationed in the pharynx and also, in some circumstances, by cervical electrodes. On separate sessions, we evaluated the effect of five test manipulations on salivary flow and swallowing rate, respectively. The test manipulations consisted of: (1) pharyngeal intubation, (2) sucking of a dummy lozenge, (3) sucking of a peppermint lozenge, (4) bethanechol injection (5 mg subcutaneously), and atropine administration (12 μg/kg intravenously). Pharyngeal intubation caused a small, but significant increase in the rate of salivation and spontaneous swallows. Sucking of a peppermint lozenge caused a sixfold increase in salivary flow while nearly doubling the swallowing rate whereas the dummy lozenge caused only a modest increase in salivary flow and swallowing. Cholinergic stimulation by bethanechol elicited a substantial increase in salivary flow and swallowing rate. In contrast, atropine caused a significant decrease in both salivary flow and swallowing. We conclude that in awake, normal subjects the rate of spontaneous swallows is influenced directly by salivary flow. Because oral lozenges substantially increase both swallowing rate and salivary flow, such agents merit investigation as a potentially useful ancillary treatment for the relief of heartburn.
TL;DR: The studies suggest that the first alcohol challenge may have elicited the synthesis and release of tissue prostaglandins and thereby enhanced resistance of the gastric mucosa to subsequent challenge by this damaging agent.
Abstract: Using a canine chambered stomach preparation, the effects of three 30-min exposures of the gastric mucosa to 20% ethanol in 100 mN HCl on gastric mucosal barrier disruption and ulcer formation were assessed. The interval between exposures was 30 min. Following an initial exposure to 20% ethanol, the net fluxes of H+, Na+, and K+ ions and perfusate volume induced by a second and third exposure of the gastric epithelium to this damaging agent were significantly reduced. Only minimal ulceration was observed following the first exposure which did not worsen with subsequent exposure to ethanol. If indomethacin was given intravenously either before or immediately after the first ethanol exposure, recovery of barrier function was significantly lessened after this challenge, and the resistance to barrier disruption was significantly decreased during the two subsequent exposures to ethanol when compared to experiments in which mucosa was exposed to 20% ethanol without concomitant administration of indomethacin. In addition, marked mucosal ulceration was observed during the second and third ethanol exposures if indomethacin was given. These studies suggest that the first alcohol challenge may have elicited the synthesis and release of tissue prostaglandins and thereby enhanced resistance of the gastric mucosa to subsequent challenge by this damaging agent. When prostaglandin synthesis was blocked by indomethacin, the increased resistance to gastric injury did not occur.
TL;DR: Results suggest that MTI may suppress pathogenesis and development of pancreatitis by inhibiting the chain reaction of pancreatic enzyme activation.
Abstract: Therapeutic effect and the mechanism of the action of human urinary trypsin inhibitor (MTI) on experimental acute pancreatitis were studied. MTI significantly increased survival rate of animals with experimental acute pancreatitis induced by the infusion of trypsin or phospholipase A2 into pancreas or by a closed duodenal loop. The efficacy of MTI on these types of pancreatitis were higher than those of aprotinin. Pancreatic enzymes were released from pancreatic slice by trypsin or phospholipase A2, and this release was inhibited by MTI. Further, these pancreatic enzymes caused a secondary release of enzymes from other pancreatic slice, suggesting that these enzymes injured pancreatic tissue and that a chain reaction of pancreatic enzyme activation may play an important role in the pathogenesis of acute pancreatitis. MTI suppressed the secondary enzyme-induced pancreatic injury more strongly than aprotinin. These results suggest that MTI may suppress pathogenesis and development of pancreatitis by inhibiting the chain reaction of pancreatic enzyme activation.
TL;DR: Chenodeoxycholic acid had drastic effects on isolated human hepatocytes by reducing the number of microvilli and disrupting cell membranes, and ursodeoxy cholic acid produced only slight morphological changes and enzyme release.
Abstract: Chenodeoxycholic and ursodeoxycholic are effective cholelitholytic agents, but differ in their side effects. Chenodeoxycholic acid administration induces diarrhea and a transient rise of GOT, which are virtually nonexistent with ursodeoxycholic acid treatment. Lithocholic acid, a bacterial metabolite of chenodeoxycholic acid, has been implicated as a possible hepatotoxin. In the present investigation, the effect of chenodeoxycholic acid or ursodeoxycholic acid and their glycine and taurine conjugates on isolated human hypatocytes was directly assessed. Chenodeoxycholic acid had drastic effects on isolated human hepatocytes by reducing the number of microvilli and disrupting cell membranes. Pronounced release of GOT was observed. In contrast, ursodeoxycholic acid produced only slight morphological changes and enzyme release. Conjugation of each respective bile acids had a moderating effect.
TL;DR: In a routine sigmoidoscopy clinic a specially trained nurse practitioner examined 825 patients between the ages of 23 and 88 with a mean age of 59, seventy-two patients were found to have polyps; only eight of these patients had a history of rectal bleding.
Abstract: In a routine sigmoidoscopy clinic a specially trained nurse practitioner examined 825 patients between the ages of 23 and 88 with a mean age of 59. Seventy-two patients were found to have polyps; only eight of these patients had a history of rectal bleeding. Seventy-nine percent of these polyps were above 25 cm or beyond the reach of the rigid scope. Three patients with polyps were found to have cancer in the polyp. None of these patients had noted rectal bleeding. Significantly, there was a 10.6% yield of positive pathology among patients 50 and over. The training of the nurse practitioner is described in the article.
TL;DR: The pathogenesis of diarrhea caused by rotavirus infection was studied in miniature swine piglets as mentioned in this paper, where the animals were inoculated orally with 2 X 10(7) plaque-forming units of porcine rotivirus (OSU strain).
Abstract: The pathogenesis of diarrhea caused by rotavirus infection was studied in miniature swine piglets. The animals were inoculated orally with 2 X 10(7) plaque-forming units of porcine rotavirus (OSU strain). During the height of diarrhea, intestinal function was investigated by in vivo perfusion of a 30-cm segment of proximal jejunum and a 30-cm segment of distal ileum. Absorption of Na+ and water decreased and 3-O-methylglucose transport was markedly reduced, P less than 0.01 compared to control animals. Mucosal lactase and sucrase levels were depressed in both the jejunum and ileum, P less than 0.001. Na+,K+-ATPase activity was significantly depressed only in the ileum, P less than 0.001. These changes were associated with a marked reduction in villous height, suggesting that the diarrhea could be an osmotic diarrhea due to nutrient (carbohydrate) malabsorption. Fresh stool samples were obtained and analyzed immediately for NA+,K+, osmolarity, glucose, and lactose; the osmotic gap was also determined. Stool osmolarity continually increased from 248 +/- 20 mosm/liter prior to inoculation to 348 +/- 20 mosm/liter at 75 +/- 1 hr postinoculation (P less than 0.005); the majority of the fecal osmotic gap could be accounted for by the amount of lactose present in the stools. Stool sodium increased from 34 +/- 6 mM prior to inoculation to a maximum of 65 +/- 4 mM at 53 +/- 1 hr postinoculation, P less than 0.001. There was no significant change in potassium concentration.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: This study suggests that in symptomatic NEMD patients, abnormal duration of peristaltic contractions, rather than abnormal amplitude, may be a distinguishing manometric feature.
Abstract: Dysphagia and chest pain are well-described symptoms in subjects with achalasia, diffuse esophageal spasm (DES), and high-amplitude peristaltic contractions, a subset of nonspecific motor disorders (NEMD). We observed a high incidence of chest pain and dysphagia in a different NEMD subgroup characterized by prolonged peristaltic contractile duration (PPCD) and normal contractile amplitude. We compared the manometric characteristics of patients with PPCD to healthy controls and compared the clinical profile of PPCD patients to that of patients with achalasia, DES, and high-amplitude peristalsis. In 2o patients with PPCD, mean contractile duration was 7.4±0.3 sec, significantly greater than healthy controls (3.7±0.1 sec) (P<0.001). PPCD was associated with an 85% incidence of chest pain and 65% incidence of dysphagia. These symptoms were similar to those observed in patients with achalasia, DES, and highamplitude peristalsis. In PPCD patients, chest pain was more frequently of long duration in comparison to achalasia and DES. PPCD was encountered more frequently than either achalasia or DES in patients referred to our laboratory. This study suggests that in symptomatic NEMD patients, abnormal duration of peristaltic contractions, rather than abnormal amplitude, may be a distinguishing manometric feature.
TL;DR: Sarcoidosis presents with normal chest roentgenograms more often than is appreciated and appears to be a common cause of unexplained persistent hepatic granulomatosis.
Abstract: The etiology of hepatic granulomatosis discovered in patients with normal chest roentgenograms is controversial. Among 18 such patients studied in recent years, sarcoidosis was identified as the cause in 15 by demonstration of granulomatous inflammation in extrahepatic tissues, employing a variety of biopsy methods. Serum angiotensin levels were raised in all 10 patients tested and gallium scans were helpful in four of six cases. Prolonged fever was the most common symptom, but three patients had severe right upper quadrant pain, a manifestation of hepatic sarcoidosis not previously described. Improvement on corticosteroids was observed in the 14 treated patients, but incomplete response led to use of cytotoxic drugs in three cases. Sarcoidosis presents with normal chest roentgenograms more often than is appreciated and appears to be a common cause of unexplained persistent hepatic granulomatosis. A firm diagnosis should be established since treatment is long and frustrating. The prognosis is good but treatment for years is required in most cases.
TL;DR: Serial measurements of these three enzyme levels in patients recovering from acute pancreatitis indicated that pancreatic isoamylase and lipase were elevated above normal to a greater extent and remained elevated much longer than did the total amylase.
Abstract: We compared results of measurements of total serum amylase, pancreatic isoamylase, and lipase measurements in patients with hyperamylasemia. Serial measurements of these three enzyme levels in patients recovering from acute pancreatitis indicated that pancreatic isoamylase and lipase were elevated above normal to a greater extent and remained elevated much longer than did the total amylase. This finding indicates an appreciable sensitivity advantage of the pancreatic isoamylase and lipase over total amylase measurement during the recovery phase of pancreatitis. Comparison of pancreatic isoamylase and lipase levels in selected sera indicated a good correlation (r=0.84) between these two measurements in patients who did not have macroamylasemia. Lipase was normal in sera with amylase elevations due solely to salivary isoamylase. Thus, in nonmacroamylsemic sera, pancreatic isoamylase and lipase appear to be roughly interchangeable markers of the level of pancreatic enzymes in the blood. An advantage of the lipase assay is that this enzyme is normal in hyperamylasemia caused by macroamylasemia, whereas the inhibitor assay indicates that the pancreatic isoamylase is elevated. Development of automated assays for either pancreatic isoamylase or lipase should lead to the routine use of one of these assays in place of the present reliance on total amylase measurements in the diagnosis of pancreatitis.
TL;DR: The high prevalence of gallstones in Crohn's disease should be considered in any patient who continues to complain of abdominal pain despite otherwise appearing to be in remission, and a bright liver echo pattern may be indicative of portal triaditis.
Abstract: Abdominal ultrasound was performed in conjunction with liver function tests in 38 patients with small bowel Crohn's disease and a similar number of age- and sex-matched healthy controls. Five (13%) patients had had previous cholecystectomies for cholelithiasis, and eight (21%) were found to have gallstones on ultrasound. Thus, a total of 34% of patients as compared with 8% of controls had gallstones (P less than 0.01). Compared with 8% of controls, 53% of patients had evidence of at least one biochemical or ultrasonic hepatobiliary abnormality (P less than 0.001). A bright liver echo pattern may be indicative of portal triaditis. The high prevalence of gallstones in Crohn's disease should be considered in any patient who continues to complain of abdominal pain despite otherwise appearing to be in remission.
TL;DR: Biochemical tests were performed upon admission in 84 patients with suspected or proven acute pancreatitis at the time of the first episode of acute abdominal pain and the SGPT was the most discriminant test between biliary and nonbiliary pancreatitis.
Abstract: Biochemical tests (serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, alkaline phosphatase, gammaglutamyltranspeptidase, bilirubin, and serum amylase) were performed upon admission in 84 patients with suspected (36) or proven (48) acute pancreatitis at the time of the first episode of acute abdominal pain suspected clinically as acute pancreatitis. These parameters all increased significantly more in patients with gallstone pancreatitis. Among them, the SGPT was the most discriminant test between biliary and nonbiliary pancreatitis. The positive predictive value of SGPT was 92%, when the cutoff point was chosen at twice the upper limit of normal. In patients with increased SGPT, a SGOT-SGPT ratio less than 1 is the rule (88%) for those with gallstone pancreatitis. This enzymatic determination allowed us to select more accurately the patients suitable for morphological procedures to confirm the biliary origin of the pancreatitis.
TL;DR: Scintigraphic technique was used to study esophageal transport of a solid bolus in 16 patients with dysphagia but with normal manometry, and negative acid perfusion tests, acid clearing tests, and pH reflux tests.
Abstract: Scintigraphic technique was used to study esophageal transport of a solid bolus in 16 patients with dysphagia but with normal manometry, and negative acid perfusion tests, acid clearing tests, and pH reflux tests. Radiology performed on 14 of the 16 patients showed no evidence of organic lesions. Half the patients had abnormal findings at scintigraphy, with either bolus retention in the upper part of the esophagus or prolonged transit time as compared to a group of 20 asymptomatic subjects. Scintigraphy can be regarded as a valuable complement in the objective documentation of dysphagia when other diagnostic methods fail.
TL;DR: During dilatation a longer segment of duct is more clearly visualized and the pancreatic juice within the duodenum improves ultrasonographic imaging of the head of the pancreas.
Abstract: In this study we evaluated the effect of secretin administration on the caliber of the Wirsung duct visualized by real-time ultrasonography. A maximal dose [75 clinical units (CU)] of secretin was intravenously injected in 1 min into 18 normal subjects. The duct was continuously monitored from the beginning of injection for a period of 20 min and measured at the level of the body using a calibrated optical lens. The mean caliber of the duct (basal value±sd=1.2±0.4 mm) markedly increased after secretin stimulation (mean value±sd at 3 min = 2.9±0.8 mm). No dilatation was observed in five of these subjects after administration of 2 ml of saline. In a further four subjects a dose of 0.25 CU/kg/hr of secretin caused a much less marked dilatation of the main pancreatic duct. During dilatation a longer segment of duct is more clearly visualized; furthermore the pancreatic juice within the duodenum improves ultrasonographic imaging of the head of the pancreas.
TL;DR: In this paper, the gallbladder and its contents were studied by ultrasonography in 31 patients with acute viral hepatitis and 23 age-matched controls, and the authors found that GBW thickness was significantly related to serum albumin (r=−0.45,P<0.004), but not to the serum transaminase levels.
Abstract: We have studied the gallbladder and its contents by ultrasonography in 31 patients with acute viral hepatitis and 23 age-matched controls. Liver cell necrosis was assessed by raised transaminase levels within 24–48 hr of ultrasonography in all patients. Gallbladder wall (GBW) measured 5.16±0.4 mm (mean±sem) in patients and 2.0±0.06 mm in controls (P 3 mm) in 21 patients (68%), with double wall appearance in 5 (16%), and sludge was seen in the gallbladder cavity in 7 (23%). GBW thickness was significantly related to serum albumin (r=−0.45,P<0.01) and bilirubin (r=0.50,P<0.004), but not to the serum transaminase levels. On repeat measurements after recovery in 13 patients, GBW thickness fell from 5.84±0.49 mm during acute hepatitis to 2.46±0.21 mm (P<0.001).
TL;DR: Achalasia has been purported to be a risk factor for the development of esophageal carcinoma as mentioned in this paper, and two approaches were employed to test the validity of this association at the Yale-New Haven Hospital (YNHH) and its major affiliate, the West Haven Veterans Administration Medical Center (WHVA).
Abstract: Achalasia has been purported to be a risk factor for the development of esophageal carcinoma. To test the validity of this association at the Yale-New Haven Hospital (YNHH) and its major affiliate, the West Haven Veterans Administration Medical Center (WHVA), two approaches were employed: (1) a prospective study identifying 100 subjects with manometrically documented achalasia for the development of esophageal cancer; (2) a retrospective review of esophageal cancer patients admitted to the YNHH and the WHVA from 1971 through 1981 for any evidence of achalasia. No cases of esophageal carcinoma were identified in the 91 evaluable achalasics. No case of achalasia was found or even suggested in association with the 153 cases of esophageal cancer reviewed. Our findings do not substantiate the association of achalasia and esophageal carcinoma. The clinical implications of this conclusion on surveillance and follow-up of achalasia patients are discussed.
TL;DR: The results suggested that the size, shape, or volume of the tablet used in this study had no significant effect in the rate of gastric emptying, and the method described is a relatively simple and accurate technique to allow one to follow the gastric emptied of tablets.
Abstract: To evaluate the gastric emptying time of pharmaceutical dosage forms in a clinical setting, a relatively simple dual-radionuclide technique was developed. Placebo tablets of six different combinations of shape and size were labeled with indium-111 DTPA and enteric coated. Six volunteers participated in a single-blind and crossover study. Tablets were given in the morning on a fasting stomach with 6 oz of water containing99mTc pertechnetate and continuously observed with a gamma camera. A scintigraph was obtained each minute. The results suggested that the size, shape, or volume of the tablet used in this study had no significant effect in the rate of gastric emptying. The tablets emptied erratically and unpredictably, depending upon their time of arrival in the stomach in relation to the occurrence of interdigestive myoelectric contractions. The method described is a relatively simple and accurate technique to allow one to follow the gastric emptying of tablets.
TL;DR: The results demonstrate that softening of stools and normalization of defecation habits should be the mainstay in the treatment of this otherwise chronic disorder with poor healing tendency.
Abstract: Twenty-one patients with a solitary ulcer of the rectum were treated with instructions for a high-fiber diet and abstention of straining at defecation, since there is evidence that the solitary ulcer syndrome is caused by chronic mechanical and ischemic trauma, by hard stools, and intussusception of the mucosa. In 15 patients disappearance of symptoms and complete ulcer healing was obtained in an average period of 10.5 months (range 2.5–21 months). In the other six patients the lesions remained unchanged. The results demonstrate that softening of stools and normalization of defecation habits should be hhe mainstay in the treatment of this otherwise chronic disorder with poor healing tendency.