Showing papers in "Journal of Clinical Gastroenterology in 1988"
TL;DR: A clinically oriented review of the literature on the role of saliva in the upper gastrointestinal tract is presented and the many problems associated with lack of saliva are reviewed.
Abstract: Saliva serves many functions in the upper digestive tract, with its roles in esophageal physiology, digestion, and gastric cytoprotection having been documented by many studies in the recent literature. Understanding the multiple functions of saliva and the consequences of its absence is of paramount importance to gastroenterologists. We present a clinically oriented review of the literature on the role of saliva in the upper gastrointestinal tract and review the many problems associated with lack of saliva. We also discuss the management of xerostomia.
248 citations
TL;DR: It is concluded that despite troublesome intestinal and systemic symptoms, most patients with IBD avoid major disruption in work and personal lives and Physicians must inquire specifically about emotional problems relating to IBD.
Abstract: To investigate the effect of inflammatory bowel disease (IBD) on the quality of life, we interviewed 43 patients with ulcerative colitis (UC) and 54 with Crohn's disease. Patients identified frequent and important problems in five areas. Primary bowel symptoms, systemic symptoms, and altered emotional function were common; functional and social impairment were less frequent. Systemic symptoms such as fatigue were more prevalent in patients with Crohn's disease. Apart from primary bowel complaints, patients seldom volunteered other facets of quality of life impairment; this was particularly true for impairment of emotional function. We conclude that despite troublesome intestinal and systemic symptoms, most patients with IBD avoid major disruption in work and personal lives. Physicians must inquire specifically about emotional problems relating to IBD; in particular, fear of surgery is important to address. Psychosocial interventions should be targeted to those patients with problems in this area.
218 citations
192 citations
TL;DR: In this paper, the authors measured the serum C reactive protein (CRP) levels by a sensitive immunochemistry method in 101 outpatients with Crohn's disease enrolled in a prospective longitudinal study.
Abstract: We measured the serum C reactive protein (CRP) levels by a sensitive immunochemistry method in 101 outpatients with Crohn's disease enrolled in a prospective longitudinal study. At entry, 51 of the 101 patients had raised CRP levels, which showed good correlation with the clinical score. However, one-third of the patients with clinically active disease had normal CRP while one-third of the patients in clinical remission had a raised CRP. The longitudinal study showed that (a) in patients with active disease, CRP levels tended to decrease as the disease went into remission; (b) in patients who achieved remission, the likelihood of clinical relapse after 2 years of entry was higher in those with persistently raised CRP than in those with persistently normal CRP; and (c) in patients with quiescent disease at entry who remained in remission throughout the first year of the study, the likelihood of clinical relapse during the second year of the study was higher for those with persistently raised CRP than for the others. This study confirms that serum CRP is a useful laboratory index for supplementing clinical scores in patients with Crohn's disease, in monitoring the response to treatment, in helping to predict the course of the disease, and in contributing to defining subgroups of patients.
165 citations
TL;DR: The cellular mechanisms, speed of migration, recovery of transmucosal electrical potential difference, and specific peculiarities of rapid epithelial restitution in the various regions of the gastrointestinal tract are reviewed here.
Abstract: Injury to the gastrointestinal mucosa can be divided into two types: (a) deep injury involving extensive hemorrhage and large areas of tissue necrosis, and (b) superficial injury confined to the upper regions of the mucosa and not involving hemorrhagic lesions. Mucosal repair differs according to the severity of the damage. Repair of deep injury takes weeks because large regions of the mucosa must be replaced with new tissue, a process involving mitosis. Superficial injury is initially repaired rapidly over hours by epithelial restitution that does not involve mitosis but proceeds in the following sequence of events: First, the damaged surface epithelial cells are shed and form a layer that protects the restituting mucosa. Then the viable epithelial cells that remain attached to the mucosa at the margin of the wound become flattened and rapidly migrate over the denuded basal lamina. The superficial epithelium is re-established when migrating cells touch, form new tight junctions, and repolarize their organelles. This rapid protective mechanism, called restitution, has recently been documented in the stomach, duodenum, colon, and rectum. The cellular mechanisms, speed of migration, recovery of transmucosal electrical potential difference, and specific peculiarities of rapid epithelial restitution in the various regions of the gastrointestinal tract are reviewed here.
145 citations
TL;DR: A review of the early medical literature reveals a surprising number of reports of inflammatory bowel disease consistent with present descriptions of these conditions, which re-emphasizes the importance of meticulous clinical and pathological descriptions in the subsequent elucidation of obscure disorders.
Abstract: Ulcerative colitis and regional enteritis (Crohn's disease), probably first appeared as isolated cases, several centuries ago; but not until the latter half of the 19th century did their clinical presentation attract medical interest as definable entities. This review of the early medical literature
99 citations
TL;DR: The Medical Record departments of the five teaching hospitals in Edmonton, plus the 37 community hospitals in the eight census districts of the northern half of the province of Alberta, Canada, were contacted, and a search was made of all patients with a discharge diagnosis of Crohn's disease or ulcerative colitis to discover patients who had never been hospitalized within these census areas.
Abstract: The Medical Record departments of the five teaching hospitals in Edmonton, plus the 37 community hospitals in the eight census districts of the northern half of the province of Alberta, Canada, were contacted, and a search was made of all patients with a discharge diagnosis of Crohn's disease or ulcerative colitis. Also, the patient records of all Edmonton gastroenterologists were reviewed to discover patients with Crohn's disease or ulcerative colitis who had never been hospitalized within these census areas. From January 1, 1977, to December 31, 1981 (which was the prevalence date), the population was 1,295,360. Of the 2,419 patients with inflammatory bowel disease, 48.5% had definite Crohn's disease and 33% had definite ulcerative colitis. There were 1,716 (70.9%) patients analyzed in this study. The factorial analysis of disease prevalence per 10(5) population revealed that significant differences were found for location of residence, sex, and age. The prevalence of Crohn's disease was higher in urban than in rural areas and in females than in males, whereas the prevalence of ulcerative colitis was unaffected by these variables. The peak prevalence of Crohn's disease was below age 29 in males and females, and the prevalence in young women at this age was approximately twice that in males. The highest prevalence of Crohn's disease was in urban females aged 20-39 (greater than 234 cases/10(5) population), with similar prevalence rates in urban males and rural females, and with the lowest prevalence rates in rural males. The incidence of Crohn's disease was greater than for ulcerative colitis, began to increase in about 1965, and reached a plateau in the late 1970s. In conclusion, the demonstration of an age, location of residence, or effect of sex on the prevalence of inflammatory bowel disease requires multiple factorial analyses. When the sample is extrapolated to the total diseased population of the region, a prevalence value of 330/10(5) was derived for young female urban individuals residing in this northern area.
91 citations
TL;DR: It was the patients' opinion that treatment with suppositories was easier than that with enemas (p less than 0.01), and no difference could be observed in terms of efficacy.
Abstract: Thirty-nine patients with documented active distal proctitis (<20 cm) received either 5-aminosalicylic acid (5-ASA) enemas (2 g in 100 ml) or suppositories 1 g b.i.d., in a controlled study. Twenty patients received enemas, while 19 patients received suppositories, for 30 days. No difference could b
75 citations
TL;DR: The ascitic fluid analysis in patients with cardiac ascites is characteristic and may assist in the differential diagnosis of ascite and red cell counts were significantly higher in cardiac ascite than in cirrhotic ascites--although cardiac Ascites was not visibly bloody.
Abstract: In a prospective study, there were 13 patients with cardiac ascites among a group of 262 ascites patients (5% of the total). I compared the characteristics of 20 ascitic fluid samples from these patients with heart failure to those of 20 patients with cirrhotic ascites. The serum-ascites albumin concentration gradient was greater than or equal to 1.1 g/dl in all patients in both groups. The ascitic fluid total protein concentration was greater than or equal to 2.5 g/dl in all patients with cardiac ascites whereas only 10% of patients with cirrhotic ascites had such high values. The ascitic fluid lactate dehydrogenase and red cell counts were significantly higher in cardiac ascites than in cirrhotic ascites--although cardiac ascites was not visibly bloody. The peripheral hematocrit of patients with cardiac ascites was also significantly higher than that of patients with cirrhotic ascites. The ascitic fluid analysis in patients with cardiac ascites is characteristic and may assist in the differential diagnosis of ascites.
72 citations
TL;DR: Current time trends for peptic ulcers are examined, finding that duodenal and gastric ulcer death rates have remained fairly constant since 1979 and hospitalizations for uncomplicated cases continue to decline, but there has been no decrease in cases with complications.
Abstract: There has been speculation that peptic ulcer is a vanishing disease. To determine current time trends for peptic ulcers, we examined data from the National Center for Health Statistics and the Commission on Professional and Hospital Activities covering the period 1970 to 1985. For duodenal ulcer, hospitalizations for uncomplicated cases continue to decline, but there has been no decrease in cases with complications (such as perforations or hemorrhages). Hospitalizations for gastric ulcer are increasing, especially for cases with hemorrhage. Duodenal and gastric ulcer death rates have remained fairly constant since 1979. Site-unspecified peptic ulcer death rates doubled in 1979 and have remained at this rate through 1983. This increase can largely be attributed to coding changes made in the 9th revision of the International Classification of Diseases.
68 citations
TL;DR: It is suggested that the ascitic fluid directly crossed the diaphragmatic defect to the pleural cavity, which contributed to the hydrothorax in a 56-year-old woman admitted with intractable shortness of breath.
Abstract: A 56-year-old woman with a 2-year history of cirrhosis of the liver and frequent right pleural effusion was admitted with intractable shortness of breath. Chest x-ray examination showed marked pleural effusion of the right lung field with a shift of the mediastinum to the left. Ascites was not conspicuous. Except for the liver cirrhosis, there was no clinical evidence of other underlying diseases. The patient died with a relatively short course after hospitalization. At autopsy, an apparent bleb with 1-mm hole in the tendinous portion of the right diaphragm was noted. We suggest that the ascitic fluid directly crossed the diaphragmatic defect to the pleural cavity, which contributed to the hydrothorax. In this article we review the pertinent literature.
TL;DR: The extent of the inflammatory mucosal lesion by colonoscopy and biopsy in 60 patients with their first attack of ulcerative colitis was estimated and 86.7% of patients were correctly classified, the errors consisting in underestimation of disease in 8/29 patients with extensive colitis.
Abstract: We estimated the extent of the inflammatory mucosal lesion by colonoscopy and biopsy in 60 patients with their first attack of ulcerative colitis. Proctitis was found in 12, proctosigmoiditis in 19, left-sided colitis in 10, and extensive colitis in 19. Fourteen clinical variables and laboratory measurements (bowel frequency, stool consistency, rectal bleeding, fecal mucus/pus, temperature, pulse rate, white blood cell count, hematocrit, sedimentation rate, serum iron, serum albumin, serum alpha 2-globulin, serum C-reactive protein, and seromucoids) were determined. All the variables except rectal bleeding and hematocrit were correlated (p less than 0.001) with the extent of colitis. On stepwise discriminant analysis, only C-reactive protein distinguished proctosigmoiditis from more improved the discrimination. Cross-validation by the "jack-knife method" showed that 86.7% of patients were correctly classified, the errors consisting in underestimation of disease in 8/29 patients with extensive colitis.
TL;DR: It is concluded that PP enemas are more active in the treatment of ulcerative proctitis, but they cause a suppression of the adrenal cortex, in contrast to BDP.
Abstract: In a double-blind randomized clinical trial 18 patients with exacerbations of distal ulcerative colitis were treated for 4 weeks with enemas containing either prednisolone 21-phosphate 30 mg (PP) or beclomethasone dipropionate 1 mg (BDP) a surface-active corticosteroid. All 8 patients treated with PP showed clinical and endoscopic improvement in contrast with only 4 of 10 patients treated with BDP. Endocrinologic evaluation showed a significant decrease in morning plasma cortisol, in cortisol increase after synacthen, and in urinary free cortisol excretion after PP therapy, but no changes in these variables after BDP therapy. We conclude that PP enemas are more active in the treatment of ulcerative proctitis, but they cause a suppression of the adrenal cortex, in contrast to BDP.
Journal Article•
TL;DR: The survie bacterienne apres 2 jours as mentioned in this paper, depend de la composition and surtout du pH du milieu, and c'est dans l'eau et le lait that les 3 bacteries survivent le plus longtemps.
Abstract: Des boissons gazeuses et alcoolisees, de l'eau et du lait ecreme sont ensemences avec des salmonelles, Shigella et E. coli enterotoxinogenes. Etude de la survie bacterienne apres 2 jours. Elle depend de la composition et surtout du pH du milieu. C'est dans l'eau et le lait que les 3 bacteries survivent le plus longtemps
TL;DR: The findings suggest that a high index of suspicion is critical and a combined effort of the internist and ophthalmologist is mandatory in patients with pyogenic liver abscess and metastatic Klebsiella endophthalmitis.
Abstract: In a consecutive series of 180 patients with pyogenic liver abscess, three patients (two men and one woman, between 46 and 75 years of age) had metastatic Klebsiella endophthalmitis. The incidence of metastatic endophthalmitis was 1.7% in patients with pyogenic liver abscess, 5.2% in patients with Klebsiella liver abscess, and 7.8% in patients with Klebsiella liver abscess having Klebsiella bacteremia. Despite aggressive therapeutic measures, the men permanently lost their vision and the woman eventually required an evisceration of her right eye. Delayed recognition and/or treatment as well as the nature of bacteria probably contributed to the tragic outcome. The findings suggest that a high index of suspicion is critical and a combined effort of the internist and ophthalmologist is mandatory.
TL;DR: Results show that cisapride, 10 mg q.i.d., heals esophagitis lesions and greatly reduces associated symptoms and the treatment was well tolerated.
Abstract: In a 6 to 12-week double-blind trial, the effect of cisapride (10 mg q.i.d.) was compared with that of placebo in 63 patients with esophagitis confirmed by endoscopy and/or biopsy. In only one patient (3%) in the cisapride group but in 43% of the placebo patients (p = 0.001), symptoms had not improved after 6 weeks. Forty patients continued treatment until week 12. At that time, control endoscopy showed a significantly (p = 0.005) higher rate of healing (no erosions, ulcers, or bleeding mucosa) in the cisapride patients (63%) than in the placebo patients (12%). At week 12, only three of the 21 cisapride patients still had moderate reflux symptoms, whereas eight of the 19 placebo patients had moderate or severe symptoms (p less than 0.05). Cisapride patients also took significantly (p less than 0.001) less antacids during the trial. These results show that cisapride, 10 mg q.i.d., heals esophagitis lesions and greatly reduces associated symptoms. The treatment was well tolerated.
Journal Article•
TL;DR: Five additional risk factors explain why cholesterol gallstone disease is so prevalent: the human species has a gallbladder, the irregular meal pattern of humans may be responsible for prolonged storage of bile, and the presence of gallstones stimulates mucous secretion, which traps cholesterol crystals.
Abstract: Symptomatic cholesterol gallstone disease occurs because of the combination of a number of biochemical and physiologic defects: formation of supersaturated bile, nucleation, crystal retention, stone growth, and gallbladder inflammation. There are several possible explanations for the high prevalence of supersaturated bile in the Western adult human as compared to other adult mammals. First, the human liver is defective in converting cholesterol to bile acids; the majority of cholesterol is eliminated as cholesterol. Second, the large flux of cholesterol in vesicular form is not matched by a large flux of recycling bile acids. Third, humans live sedentary lives and voluntarily reduce their caloric requirement to prevent obesity. Low caloric intake decreases the circulation of bile acids (including the flux through the hepatocyte). Fourth, the human species is a defective bile secretor in terms of biliary volume (microliter/kg-min) compared to other mammals. This is because human enterohepatic circulation of bile acids is "sluggish" and because bile acid-independent flow is also lower than in all other mammals. The accumulation of deoxycholic acid, a secondary bile acid formed in the colon, appears to cause secretion of bile that is supersaturated in cholesterol, and may also contribute. Five additional risk factors explain why cholesterol gallstone disease is so prevalent. First, the human species has a gallbladder, and the irregular meal pattern of humans may be responsible for prolonged storage of bile. Second, bile from cholesterol gallstone patients nucleates cholesterol more rapidly. Third, defective gallbladder contraction is associated with cholesterol gallstone disease in the majority of gallstone patients. Fourth, the healthy gallbladder absorbs cholesterol and desaturates bile--protective functions that may be lost with chronic cholecystitis. Finally, the presence of gallstones stimulates mucous secretion, which traps cholesterol crystals.
TL;DR: It is concluded that atypical or nonclassical presentations of adult celiac sprue, mostly with hematologic abnormalities, are not uncommon.
Abstract: We report the clinical, laboratory, and pathological findings in a series of 52 consecutive patients with adult celiac sprue observed over a 20-year period. The frequency of that diagnosis increased from an average of 0.7 case/year during the period 1966–1975 to 5.8 cases/year during the period 1981 −1985. Apart from two patients with dermatitis herpetiformis, nonclassical clinical presentations were observed in 16 of 50 (32%) patients overall and in 13 of 28 (46%) patients diagnosed since 1981. Diarrhea was the most common complaint leading to the diagnosis; since 1981, hematologic abnormalities warranted investigation in 38% of the patients. Decreased iron stores (88%), decreased red cell folate (82%), or both (74%), and abnormal radiographic studies of the small bowel (83%) were the most sensitive tests in the diagnostic investigation. We conclude that atypical or nonclassical presentations of adult celiac sprue, mostly with hematologic abnormalities, are not uncommon.
TL;DR: The study suggests that drug dependence is not recognized often enough in patients with inflammatory bowel disease and that patients with certain psychiatric disorders are at higher risk of developing it.
Abstract: Thirteen of 43 patients (30%) with inflammatory bowel disease referred for psychiatric consultation were found to be drug dependent, most commonly on oral narcotics. Drug dependence was more frequent in patients with Crohn's disease than ulcerative colitis and many had a borderline personality disorder. The study suggests that drug dependence is not recognized often enough in patients with inflammatory bowel disease and that patients with certain psychiatric dis-orders are at higher risk of developing it. Recognition of drug dependence is aided by interviewing family members. It is best prevented by seeking and treating the specific cause of pain and by having only one physician assigned to prescribe and manage narcotics.
TL;DR: I have reviewed the English language literature on angiodysplasia of the upper gastrointestinal tract and found that despite recurrent gastrointestinal bleeding, the endoscopic diagnosis is difficult because the lesions are so small and so similar to fresh blood.
Abstract: I have reviewed the English language literature on angiodysplasia of the upper gastrointestinal tract. Angiodysplasia is a distinct mucosal vascular lesion associated with acute or chronic gastrointestinal bleeding. Its etiology is unknown, but theories of its pathogenesis have evolved from its similarity to colonic angiodysplasia and an association with renal failure. Despite recurrent gastrointestinal bleeding, the endoscopic diagnosis is difficult because the lesions are so small and so similar to fresh blood. Endoscopic ablation by electrocautery or laser photocoagulation can reduce bleeding or make it stop, but repeated treatments are often necessary.
TL;DR: It is concluded that a small but important number of patients with Crohn's disease have hyperamylasemia not associated with overt pancreatitis, and in the absence of appropriate indications, it requires no investigation.
Abstract: We determined the prevalance and significance of hyperamylasemia in 180 patients with idiopathic inflammatory bowel disease (IBD) (83 with ulcerative colitis, and 97 with Crohn's disease). Serum total amylase and pancreatic and salivary isoamylase activity were measured in all patients. In all patients with hyperamylasemia, we measured isoamylase activity by cellulose acetate electrophoresis and lipase activity, assayed for the presence of macroamylase, and carried out pancreatic ultrasound examination and barium studies of the upper gastrointestinal tract. Eight of 97 patients with Crohn's disease (8%) had hyperamylasemia; 4 of them had an elevated pancreatic isoamylase and 2 a raised lipase activity. All patients with hyperamylasemia had normal ultrasonographic scans of the pancreas and no evidence of duodenal involvement on barium meal. None had macroamylasemia. We found no relationship of hyperamylasemia to disease site, activity, and duration or therapy and no patient developed clinical evidence of pancreatitis. We conclude that a small but important number of patients with Crohn's disease have hyperamylasemia not associated with overt pancreatitis. In the absence of appropriate indications, it requires no investigation.
TL;DR: The results suggest that, although the metabolic impact of active ulcerative colitis is mild, it does result in negative energy and nitrogen balances, and dietary intake can be voluntarily increased during hospitalization to improveEnergy and nitrogen equilibrium.
Abstract: Resting energy expenditure and nitrogen balance were measured shortly after admission and shortly before discharge or colectomy in eight adult males hospitalized for active ulcerative colitis. The measured resting energy expenditure was 19% higher than that predicted by the Harris-Benedict formula (p less than 0.01). Fecal and urinary nitrogen losses were 2.1 +/- 1.5 g/day and 13.6 +/- 3.8 g/day, respectively. During the early hospitalization period, daily intakes of calories (1,826 +/- 1,050 kcal) and protein (1.5 +/- 0.4 g/kg) were not sufficient to maintain energy (-548 +/- 964 kcal/day) and nitrogen (-1.5 +/- 3.9 g/day) balances. Energy expenditure and nitrogen losses at the end of the study were similar to the values obtained on admission, but because of a voluntary increase in caloric (by 42%) and protein (by 37%) intake during the hospitalization both energy balance (+434 +/- 409 kcal/day) and nitrogen balance (+4.6 +/- 6.5 g/day) (p less than 0.05) improved. These results suggest that, although the metabolic impact of active ulcerative colitis is mild, it does result in negative energy and nitrogen balances. Dietary intake can be voluntarily increased during hospitalization to improve energy and nitrogen equilibrium.
TL;DR: A male patient with cirrhosis presented with acute right upper quadrant pain, systemic hypotension, and falling hematocrit, and abdominal computed tomography scan demonstrated a large hepatic mass consistent with hepatocellular carcinoma (HCC), which leads to a discussion of the differential diagnosis of acute hemoperitoneum.
Abstract: A male patient with cirrhosis presented with acute right upper quadrant pain, systemic hypotension, and falling hematocrit. Abdominal paracentesis confirmed acute hemoperitoneum, and abdominal computed tomography (CT) sean demonstrated a large hepatic mass consistent with hepatocellular carcinoma (H
Journal Article•
TL;DR: A preliminary study found that also lower doses were effective in primary biliary cirrhosis, and highly significant decreases in serum enzyme levels were seen with the 250 mg/day dose, which were further improved by the higher doses.
Abstract: Different bile acids have different effects on liver cells, depending on the degree of hydroxylation of the bile acid and the orientation of hydroxy groups. In decreasing order of hydrophobicity, and therefore hepatotoxicity, the bile acids may be ranked as follows: lithocholic greater than deoxycholic greater than chenodeoxycholic greater than cholic greater than ursodeoxycholic acid. The rationale for the use of ursodeoxycholic acid in chronic liver disease is to increase the overall hydrophilicity of the bile acid pool, which, because of cholestasis, retains potentially hepatotoxic bile acids. Recent clinical studies have indicated that ursodeoxycholic acid improves liver function indices in patients with primary biliary cirrhosis and chronic hepatitis at doses ranging between 10 and 15 mg/kg/day. These doses would be considered in the high range in the use of ursodeoxycholic acid for gallstone dissolution. In a preliminary study we found that also lower doses were effective in primary biliary cirrhosis. Two studies to determine the optimal dose of ursodeoxycholic acid for chronic hepatitis and anicteric primary biliary cirrhosis were then carried out. Eighteen patients with primary biliary cirrhosis and 12 patients with chronic hepatitis were treated with 250, 500, and 750 mg of ursodeoxycholic acid per day for three consecutive 2-month periods. Highly significant decreases in serum enzyme levels were seen with the 250 mg/day dose, which were further improved by the higher doses. The improvement roughly paralleled the enrichment of conjugated bile acids with ursodeoxycholic acid. A separate study investigating the effect of shifting the bile acid pool composition toward less detergent moieties was also done.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: Sixty-three consecutive reexcisions of bowel for recurrent Crohn's disease where the former excision had removed all apparent disease were studied to suggest a central role for ulceration in this disease.
Abstract: Sixty-three consecutive reexcisions of bowel for recurrent Crohn's disease where the former excision had removed all apparent disease were studied. Nine pathologic parameters (small ulcers, granulomas, regeneration, metaplasia, submucosal lymphoid follicles, transmural inflammation, large ulcers, sinuses, and strictures) were correlated to the interval of time since the former excision to document the disease progression. By regression analysis, only the presence of strictures or large ulcers correlated with time. First quartile times suggest that small ulcers and granulomas were the earliest lesions of those studied. Regeneration, metaplasia, submucosal lymphoid follicles, and transmural inflammation appear to be sequelae of ulceration. Sinuses and strictures are late complications of ulceration. The results confirm clinical, radiological, and subjective pathological impressions of the progress of the disease and suggest a central role for ulceration in this disease.
TL;DR: It is concluded that methylprednisolone was effective in the prevention of relapses for patients in clinical remission but with altered lab tests.
Abstract: In Crohn's disease, prednisone is believed to be ineffective for relapse prevention. Because all patients with Crohn's Disease Activity Index lower than 150 and with some altered lab tests (erythrocyte sedimentation rate, C-reactive protein, alpha-1 -acid gly coprotein, alpha-1 -acid antitrypsin, and white blood cell count) had a clinical relapse in 18 months of follow-up, we tried to ascertain whether methylprednisolone could reduce the risk of clinical relapse in such patients. Eighteen patients were included in a controlled study against placebo. Nine patients were treated with methylprednisolone at a dosage of 0.25 mg/kg daily for a period of 6 months; treatment was discontinued if disease relapsed or if lab tests were normalized. During the steroid treatment, 1 of 9 patients showed a clinical relapse; in 7, the normalization of lab tests was obtained; in 5 of these 7 patients a relapse occurred within 1 month after the suspension of the treatment; in 1 patient, lab tests remained altered. In those 9 patients on placebo, relapses occurred in 7. We conclude that methylprednisolone was effective in the prevention of relapses for patients in clinical remission but with altered lab tests.
TL;DR: This experience confirms that estrogen-progesterone therapy may promote cessation of bleeding gastrointestinal telangiectasias and indicates the need for controlled investigations.
Abstract: A 56-year-old woman with Osler-Weber-Rendu disease had longstanding iron deficiency anemia from recurrent melena Since neither laser photocoagulation nor surgery were successful in stopping the increasing transfusion need, combined estrogen-progesterone therapy was started Except for slight bleeding from a temporary ileostomy, the bleeding and need for transfusion terminated promptly This experience confirms that estrogen-progesterone therapy may promote cessation of bleeding gastrointestinal telangiectasias and indicates the need for controlled investigations
TL;DR: It is concluded that the protective effect of EGF on the gastric mucosa is, in part, mediated indirectly by increases in SLI, PGE2, and mucus production, and β-urogastrone, human EGF, might prove to be an effective drug in the clinical treatment of gastric ulcers.
Abstract: In experimental studies, 0.6 N HCl-induced gastric mucosal injury was significantly severe in submandibularectomized rats (SMR rats) than that in either SMR rats receiving exogenous mouse EGF (SMR + EGF rats) or controls. This was also true in gastric injury induced by 0.4 N HCl under pretreatment with indomethacin to reduce gastric mucosal prostaglandins (PGs). Somatostatin (SLI), PGE2, and PAS-stained mucus in the corpus were significantly reduced in SMR rats in comparison to SMR + EGF and control rats. In clinical studies, salivary EGF secretion was much higher in peptic ulcer patients than healthy controls. beta-Urogastrone was effective in the treatment of gastric ulcers. On the basis of experimental studies, we conclude that the protective effect of EGF on the gastric mucosa is, in part, mediated indirectly by increases in SLI, PGE2, and mucus production. However, endogenous, as well as exogenous, EGF has an important direct, cytoprotective effect on the gastric mucosa. From the clinical studies, we also conclude that salivary EGF secretion in ulcer patients increases in a homeostatic response to the presence of an ulcer, facilitating ulcer healing. Furthermore, we believe that beta-urogastrone, human EGF, might prove to be an effective drug in the clinical treatment of gastric ulcers.
TL;DR: Based on preliminary data, it is believed that the finding of hyperplastic polyps in the rectosigmoid might justify full colonoscopy and that this should be studied further.
Abstract: Although hyperplastic polyps are generally believed to have no malignant potential, recent work has suggested that they might be more common in patients with adenomas. We evaluated whether hyperplastic polyps could serve as a marker for patients who might benefit from colonoscopy. We retrospectively
TL;DR: A layer of water-insoluble mucus gel has been shown to form a continuous cover over the gastroduodenal mucosal surfaces, of median thickness of 180 μm in stomach in humans, which is the first line in mucosal defence against the natural aggressors, acid and pepsin in the lumen.
Abstract: A layer of water-insoluble mucus gel has been shown to form a continuous cover over the gastroduodenal mucosal surfaces, of median thickness of 180 micron in stomach in humans. This adherent mucus is the first line in mucosal defence against the natural aggressors, acid and pepsin, in the lumen. Mucus gel provides a stable unstirred layer that supports surface neutralisation of acid by mucosal bicarbonate. Mucus gel is a diffusion barrier to pepsin in the lumen, preventing proteolysis of the underlying epithelial cells. There is, however, a dynamic balance between digestion by pepsin of the mucus layer at its luminal aspect and secretion of new mucus by the epithelium. There is evidence that, in peptic ulcer disease, the rate of peptic degradation of the mucus barrier is increased. Exogenous damaging agents such as ethanol and aspirin permeate the gel matrix of the mucus barrier, rapidly damaging the underlying epithelium. The subsequent reepithelialisation process is protected by a gelatinous coat over ten times thicker than the original adherent mucus layer. This gelatinous coat is primarily a fibrin-based gel with necrotic cells and mucus.