[Diagnostic and therapeutic problems in angiodysplasias of the digestive tract]

After a review of recent literature on angiodysplasias of the digestive system, a diagnostic procedure based on personal experience is proposed for haemorrhagic patients. Criteria for the selection of treatment protocols are then proposed for cases where angiodysplasia is recognised as the cause of the bleeding.

Adenomatous polyps and familial incidence of colorectal cancer

The frequency of colonic adenomatous polyps and the incidence of colorectal cancer in close relatives were evaluated in a prospective study performed in 100 consecutive patients operated on for colorectal cancer. One hundred patients matched for age and sex, in whom double contrast enema and colonoscopy failed to show cancer, served as control group. Colorectal carcinomas in first-degree relatives were found in 11% of the surgically treated patients and 6% of the control group (the difference is not statistically significant). Solitary or discrete adenomas in patients operated on for colorectal carcinomas were significantly more frequent (32%) than in the control group (18%) (P less than 0.05). This difference is also statistically significant when considering only those patients without relatives suffering from carcinoma; however, the same cannot be statistically proven with the small group of patients with a positive family history. Present findings do not indicate that single or discrete adenomas synchronous with colorectal cancer are significantly associated with a familial history of large bowel malignancy. These findings are consistent with the hypothesis of environmental factors being involved in adenoma pathogenesis.

Blind pan-esophageal brush cytology. Diagnostic accuracy

A non-endoscopic abrasive panesophageal method of detecting malignant cells is described. This method showed a high specificity and an acceptable sensitivity as compared with endoscopic abrasive guided cytology, and is suitable for screening patients at risk of developing esophageal malignancy, and in the follow-up of patients who have undergone radical surgery.

"Splitting" and stretching dilation of esophageal strictures

The "Splitting" action of metal olives, and the stretching effect of tapering Neoplex tubes of increasing diameter on dysphagia in a group of 55 consecutive patients with esophageal strictures are compared. Dilators were passed over a fibreoptic endoscopically positioned guide wire. Greater relief of dysphagic symptoms was obtained with the stretching procedure, mainly in postanastomotic and peptic strictures. Both procedures were safe, but the stretching technique was easier and resulted in wider dilations in most patients. Consecutive dilations using stretching procedures in malignant strictures appear to be an appropriate easy and safe alternative to endoprosthesis insertion.

Left-sided stenosing lesions in colonoscopy

Of 2625 consecutive colonoscopic examinations, 122 stenotic lesions interfered with endoscopy. The sigmoid was the most frequent site of stenosis (64%). Of the two types of endoscopic patterns, type A, in which there is an intraluminal protruding mass, is the most frequent, and type B, in which a segment of colon gradually narrows, has intact mucosa. Adenocarcinoma was the most frequent cause of type A (83%), and complications related to diverticular disease (32%) and adenocarcinoma (27%) were most often associated with type B. Colonoscopy, guided multiple biopsies, and brushing cytology gave high diagnostic accuracy for type A lesions. In type B cases, brushings were usually negative.

Left-sided colonoscopy in screening programs. What preparation?

In order to limit patients' refusal to undergoing colorectal cancer endoscopic screening procedures, traditional cleansing enemas were compared with a new simpler oral cleansing preparation by means of a randomized controlled trial. Ninety-three patients were evaluated both for compliance and effectiveness of the two modalities tested. No difference in acceptability or effectiveness was detected. The authors discuss more rigorous cleansing techniques routinely used in diagnostic schedules which cannot be considered for preparation for colonoscopy in screening programs.

Atrophic gastritis and intestinal metaplasia in asymptomatic Hungarian and Italian populations

The histological patterns of the gastric mucosa obtained by endoscopic biopsy were evaluated in two different ethnic groups, each containing one hundred patients without gastro-intestinal diseases. The incidence of atrophic gastritis and intestinal metaplasia increased with age in both groups, revealing a statistically significant difference above 60 years. The comparative study of gastric cancer death rates in the two population groups showed a significant prevalence in the Hungarians above 50 years. This fact seems to support the hypothesis that an ethnic group with high gastric cancer rate has a higher prevalence of atrophic gastritis and intestinal metaplasia in the older age groups, and offers additional evidence for the association of chronic inflammatory changes of the gastric mucosa with malignant gastric cancer.

Gastric Stump Carcinoma after Resection for Benign Gastric or Duodenal Ulcer

33 cases of cancer of the gastric stump after gastrectomy for peptic ulcer observed between 1963 and 1972 are reviewed. In 26 patients the average interval between operation and carcinoma detection was over 20 years. No cases of carcinoma occurred in less than 10 years. All patients came too late for surgery, since they had attributed their symptoms to the previous operation. The gradual increase in the gastric-cancer risk of operated patients with time suggests a continuous carcinogenic influence. Regurgitation of duodenal contents through the Billroth II anastomosis seems to be the most important cause of postoperative atrophic gastritis, which is now considered by many authors to be a condition predisposing to gastric cancer. Gastric resection patients should be regarded as a high gastric-cancer risk group. The periodic use of modern procedures for early gastric cancer detection in this group of patients is therefore justified.

Congestive and hemorrhagic lesions of duodenal mucosa. Critical evaluation

In 34 patients congestive, hemorrhagic lesions were detected by endoscopy. It was considered that trauma was not responsible for these lesions. In all of the patients except four, histology showed no inflammatory reaction. Most of the patients were hypochlorhydric and one was achlorhydric. Serum gastrin levels appeared within a normal range under fasting and stimulated conditions. Twenty-four patients were followed up two years later. Only 1 patient had developed a duodenal ulcer. The endoscopic picture appeared unmodified in the reendoscopized patients. It is concluded that the hemorrhagic lesions of the duodenum may result from local vascular disorders without any inflammation.

Gastric reflux measurements during duodenal infusion with saline, acid and fat

Duodeno-gastric reflux measured in 18 patients without gastrointestinal complaints showed a wide variation of regurgitation rates. Duodeno-gastric reflux was significantly diminished during duodenal acidification. The effect was more intense and lasted longer after olive oil infused intraduodenally, leading practically to a closed pylorus.