Diverticular disease of the colon: ethnic differences in frequency

BACKGROUND

Colonic diverticular disease is more common in Western populations than in developing countries.

AIM

To determine whether the frequency of colonic diverticular disease is different in British patients of Indian-subcontinent Asian origin compared with other ethnic groups.

METHODS

All colonoscopies performed over a 3-year period in a London hospital were studied. Patients of Indian-subcontinent Asian origin were identified by name.

RESULTS

Five of 134 Indian-subcontinent Asian males (4%) had colonic diverticular disease, compared with 278 of 1268 patients of other ethnic groups (22%; P < 0.001). Five of 91 Indian-subcontinent Asian females (6%) had colonic diverticular disease, compared with 333 of 1486 patients of other ethnic groups (23%; P < 0.001). Although patients of Indian-subcontinent Asian origin (54.8 +/- 15.8 years) were younger than those of other ethnic groups (60.3 +/- 17.8 years; P < 0.0001), the ethnic difference in the frequency of diverticular disease persisted even when age was taken into account.

CONCLUSION

There is a lower frequency of colonic diverticular disease in Indian-subcontinent Asians presenting for colonoscopy, compared with other ethnic groups. This cannot be explained by sex or age differences. Our findings require confirmation, but may provide opportunities for research into the aetiology of colonic diverticular disease.

Decline in admission rates for acute appendicitis in England

BACKGROUND

The incidence of acute appendicitis declined in western countries between the 1930s and the early 1990s. The aim of this study was to determine time trends in hospital admissions for acute appendicitis in England between 1989-1990 and 1999-2000, and in population mortality rates for appendicitis from 1979 to 1999.

METHODS

: Hospital Episode Statistics for admissions were obtained from the Department of Health and mortality data from the Office for National Statistics.

RESULTS

Between 1989-1990 and 1999-2000, age-standardized hospital admission rates for acute appendicitis decreased by 12.5 per cent in male patients and by 18.8 per cent in female patients. The proportions of admissions that resulted in operation remained stable. Admission rates for non-specific mesenteric lymphadenitis fell. Admission rates for abdominal pain increased between 1989-1990 and 1995-1996, at which time the International Classification of Diseases codes changed. Between 1995-1996 and 1999-2000, admission rates for abdominal pain declined. Analysis of age-specific admission rates for acute appendicitis and abdominal pain from 1989-1990 to 1995-1996 showed that the decline in acute appendicitis could not be accounted for by a change in diagnostic practice. Mortality rates for acute appendicitis remained stable over the study period.

CONCLUSION

Admission rates for acute appendicitis declined over the study period. This decline cannot be explained by reclassification.

Diverticular disease of the colon--on the rise: a study of hospital admissions in England between 1989/1990 and 1999/2000

BACKGROUND

Diverticular disease emerged as a common problem in Western countries over the course of the 20th century.

AIMS

To determine the time trends in diverticular disease for hospital admissions in England between 1989/1990 and 1999/2000 and population mortality rates from 1979 to 1999.

METHODS

Hospital Episode Statistics were obtained from the Department of Health and mortality data from the Office for National Statistics.

RESULTS

Between 1989/1990 and 1999/2000, annual age-standardized hospital admission rates for diverticular disease increased by 16% for males (from 20.1 to 23.2 per 100,000) and 12% for females (from 28.6 to 31.9 per 100,000). Female rates were significantly higher than male rates throughout the study period. The proportions of admissions with an operation increased by 16% for males (from 22.9% to 24.1%) and 14% for females (from 19.7% to 22.3%). Older patients were less likely to undergo operation than younger patients. In-patient case fatality rates and population mortality rates remained unchanged.

CONCLUSIONS

Admission rates for diverticular disease increased over the study period. The proportion of patients who underwent operation increased, but in-patient and population mortality rates remained unchanged. With an ageing population, diverticular disease will become an increasingly important clinical problem in England.

Trends in oesophageal and gastric cancer incidence, mortality and survival in England and Wales 1971-1998/1999

BACKGROUND

In England and Wales, 7% of cancers diagnosed in 1997 were oesophageal or gastric cancer.

AIM

To review the epidemiology of these cancers in England and Wales using cancer registration data from 1971 to 1998 and mortality data from 1971 to 1999.

METHODS

We calculated age-specific and age-standardised incidence and mortality rates; crude and relative survival by age group; age-standardised relative survival; and relative survival by socio-economic status.

RESULTS

The age-standardised incidence of oesophageal cancer increased from 7.6 to 12.8 per 100,000 men and from 4.2 to 5.7 per 100,000 women. The incidence of gastric cancer decreased from 31.8 to 18.9 per 100,000 men and from 15.1 to 7.3 per 100,000 women. For both cancers, the 1- and 5-year age-standardised relative survival improved for men and women from 1971-1975 to 1992-1994; the 5-year age-standardised relative survival was significantly higher in women than in men diagnosed in 1992-1994; for some periods from 1971-1975 to 1986-1990, the 1-year relative survival was significantly higher in the least deprived men than in the most deprived men.

CONCLUSIONS

Survival improved for both cancers over the study period, but there were unexplained differences related to sex and deprivation.

Trends in the subsite and morphology of oesophageal and gastric cancer in England and Wales 1971-1998

BACKGROUND

The incidence of adenocarcinoma of the oesophagus and gastric cardia has increased in many countries.

AIM

To describe the trends in the subsite and morphology of oesophageal and gastric cancer using cancer registry data from 1971 to 1998.

METHODS

We calculated the overall age-standardised incidence in each year; the age-standardised incidence by subsite, by morphology and by subsite and morphology; and the ratio of the rates in men and women in 1971 and 1998.

RESULTS

The incidence of oesophageal adenocarcinoma increased from 1.5 to 7.0 per 100,000 men and from 0.4 to 1.5 per 100,000 women. The incidence of cancer at the cardia also increased, from 2.0 to 5.4 per 100,000 men and from 0.6 to 1.4 per 100,000 women, but the incidence of gastric cancer without a specified subsite decreased markedly from 21.3 to 9.3 per 100,000 men and from 10.7 to 4.2 per 100,000 women.

CONCLUSIONS

Although some of the increase in the incidence of adenocarcinoma of the gastric cardia is probably real, this interpretation is limited by the proportion of cancers without specified subsites or morphologies.

5-Hydroxytryptamine attenuates free radical injury in primary mouse cortical cultures

The effects of 5-hydroxytryptamine (5-HT) on several types of neuronal injury in mouse cortical cell cultures were tested. Co-treatment with 5-HT prevented free radical-mediated neuronal necrosis induced by FeCl2 or buthionine sulfoximine (BSO) in a dose-dependent manner. Subtype antagonists did not reverse the protective effect and 5-HT showed direct free radical scavenging activity evidenced by its ability to reduce the stable free radical 1,1-diphenyl-2-picrylhydrazyl (DPPH) in a cell-free system. Excitotoxic necrosis induced by NMDA or apoptosis induced by staurosporine was not sensitive to 5-HT treatment. These features raise the possibility that the endogenous neurotransmitter 5-HT may work as an innate antioxidant defense mechanism in the CNS.

Esophageal mucosal acid sensitivity can coexist with normal pH recording in healthy adult volunteers

We aimed to determine whether healthy volunteers with normal pH monitoring study results experienced heartburn or discomfort during an esophageal acid perfusion test. We performed an esophageal acid perfusion test, followed by ambulatory esophageal pH monitoring, in 15 healthy and asymptomatic volunteers (aged 19 to 34 years). The results of the acid perfusion test were correlated with those of the pH monitoring. Three subjects (20%) reported chest discomfort during acid perfusion. The pH data in all subjects were within our laboratory reference ranges; the median (range) percent total time at pH < 4 being 1.7 (0.2-4.0)% [laboratory reference, median (range), 3.0 (0.2-4.0)%]. We concluded that direct infusion of acid onto the distal esophagus can produce discomfort akin to that of gastroesophageal reflux disease in asymptomatic adult volunteers, even in the absence of excessive esophageal acid exposure.

Hyperfibrinogenemia is an independent risk factor for atherosclerotic renal artery stenosis

It is important to identify patients at risk for atherosclerotic renal artery stenosis because renal artery stenosis is a progressive disease and a potentially correctable problem. To determine the risk factors for atherosclerotic renal artery stenosis, we performed renal arteriography at the time of cardiac catheterization in 270 patients (M:F, 193:77, mean age: 59 years) with clinical ischemic heart disease. Before the procedure, demographic data, medical history, physical findings and laboratory data were obtained. The degree of coronary artery stenosis and renal artery stenosis was quantified with automatic edge detection technique. Significant renal artery stenosis, defined as a narrowing of the diameter by more than 50%, was identified in 28 (10%) patients. Three patients (1%) had bilateral disease. Significant coronary artery disease, defined as a narrowing of the diameter by more than 50%, was present in 231 patients (85%). By univariate logistic regression analysis, older age (68 +/- 8 vs. 58 +/- 10 years), the presence of hypertension (61% vs. 38%), the extent of coronary artery disease, a high fibrinogen level (391 +/- 93 mg/dl vs. 335 +/- 109 mg/dl), a low albumin level (3.9 +/- 0.4 g/dl vs. 4.1 +/- 0.4 g/dl), and a low hemoglobin level (12.5 +/- 1.6 g/dl vs. 13.5 +/- 1.6 g/dl) were associated with the presence of renal artery stenosis (p < 0.05). Serum lipids, lipoprotein(a), creatinine, sex, smoking, or diabetes were not associated. By multivariate logistic regression analysis, older age (OR: 2.43 analyzed by 10 years increment, p = 0.0001), the presence of hypertension (OR: 2.68, p = 0.039) and a higher fibrinogen level (OR: 1.63 analyzed by 100 mg/dl increment, p = 0. 038) were significant risk factors of renal artery stenosis. Fibrinogen level was negatively correlated with albumin level (r = -0.18, p = 0.004). These results suggest that hyperfibrinogenemia as well as old age and hypertension are independent risk factors for atherosclerotic renal artery stenosis.

Patterns of consultation and treatment for heartburn: findings from a Singaporean community survey

BACKGROUND

The prevalence of reflux-type symptoms among community individuals in Singapore is low.

AIM

To describe the healthcare-seeking behaviour of those subjects with heartburn.

METHODS

A cross-sectional survey, using a reliable and valid questionnaire, was carried out on a race-stratified random sample of residents, aged 21-95 years, in a Singaporean town; 93% responded (n = 696).

RESULTS

The ethnic-adjusted prevalence of heartburn for the past 1-year was 4.6%. Sixteen (30%) of the 53 heartburn sufferers had sought consultation for their symptoms. They were more likely to have severe heartburn (P<0.001), and to have complained of nocturnal awakening due to heartburn (P<0.05) than those who did not present to medical attention. Ethnic origin did not influence the consultation pattern. Only 18 (34%) of the 53 heartburn sufferers received pharmacological therapy for their symptoms. The most commonly used medication was antacid. Medication use was associated with symptom severity (P<0.05), but not ethnicity.

CONCLUSIONS

Heartburn is uncommon in the general population of Singapore. Few heartburn sufferers seek medical attention, and most do not receive medications for symptomatic control. The decision to seek medical advice and/or to medicate was generally linked to symptom severity, but not to ethnicity.

Different prevalences of reflux oesophagitis and hiatus hernia among dyspeptic patients in England and Singapore

OBJECTIVE

To compare the frequency of reflux oesophagitis and hiatus hernia in dyspeptic patients in England with that in Singapore.

DESIGN

Demographic, clinical and endoscopic findings in consecutive dyspeptic patients seen in England and Singapore by the same clinician were compared. The association of various factors with the occurrence of hiatus hernia and oesophagitis was analysed by logistic regression.

SETTING

District general hospital in England and university hospital in Singapore.

PARTICIPANTS

The English series comprised 212 consecutive patients, and 173 patients were seen in Singapore.

RESULTS

Reflux oesophagitis and hiatus hernia were found in 52 (25%) and 50 (49%) of the English patients, and 12 (6%) and 7 (4%) of the Singapore patients, respectively (P<0.005 in each case). Race, body mass index and age were independently associated with hiatus hernia (odds ratios 3.07, 1.08 and 1.04, respectively). The risk factors for oesophagitis were race, sex, body mass index and age (odds ratios 4.04, 2.37, 1.11 and 1.02, respectively). If hiatus hernia was included in the analysis, the risk factors were hiatus hernia, sex, race and body mass index (odds ratios 20.10, 3.07, 2.81 and 1.09, respectively).

CONCLUSIONS

Reflux oesophagitis and hiatus hernia are more common in English dyspeptic patients compared to those in Singapore. The most important risk factor for both oesophagitis and hiatus hernia is race.

A prospective study of the clinical features, manometric findings, incidence and prevalence of achalasia in Singapore

BACKGROUND

This study aimed to describe the clinical features, manometric findings, prevalence and incidence of achalasia in Singapore.

METHODS

A total of 615 new patients referred for oesophageal manometry between 1989 and 1996 were examined prospectively. Twenty-four men and 25 women fulfilled the manometric and clinical criteria for achalasia.

RESULTS

Their median age of onset of symptoms was 37 years (range 15-71) and 37% first developed symptoms after the age of 50 years. The presenting symptoms were dysphagia (100%), regurgitation (80%), weight loss (67%) and chest discomfort (33%). Five patients (10%) had a history of benign (mostly autoimmune) thyroid disorders. Endoscopy was reported as normal in 10/43 patients (23%) and achalasia was suggested in only 31 (72%) of 43 barium examinations. Lower oesophageal sphincter (LOS) dysfunction was present in 82% of cases. Using data from medical records and from a survey of gastroenterologists and surgeons in Singapore, the prevalence (in 1996) and incidence of achalasia in Singapore were estimated to be 1.8 per 100000, and 0.3 per 100000 per year, respectively. The incidence was significantly lower in Malays than Chinese or Indians. The age-specific incidence of achalasia for both genders followed a bimodal distribution with the larger peak in the sixth decade. No cases of oesophageal carcinoma were identified among these patients.

CONCLUSION

Achalasia is an uncommon condition in Singapore. The clinical and manometric features were similar to those described in Western countries.

Peptic ulcer and gastritis in uraemia, with particular reference to the effect of Helicobacter pylori infection

AIMS

To determine: (i) the prevalence of histological gastritis and peptic ulcer; and (ii) the clinical features of peptic ulcer, in patients with end-stage renal failure.

METHODS

Upper endoscopy was performed by a single observer in 268 patients with end-stage renal failure over a 6-year period. Gastric histology and Helicobacter pylori status were studied in 40 consecutive subjects in whom there were no contraindications for gastric biopsy and who had not used antibacterial drugs in the preceding 4 weeks. As there are only limited data for healthy volunteers in Singapore, 33 age-, sex- and race-matched patients with functional dyspepsia from an earlier drug trial and 18 healthy volunteers who were not age-matched were used as controls. The clinical features of 43 consecutive uraemic patients with peptic ulcer were compared with those of 118 consecutive non-uraemic peptic ulcer patients seen by the same author.

RESULTS

Among uraemic patients, histological gastritis was less common, compared with healthy volunteers and functional dyspepsia patients. Helicobacter pylori infection as assessed by histology was also less common among uraemic patients compared with functional dyspepsia patients, but the difference was not statistically significant on serological assessment. Uraemic patients with ulcer had an equal sex ratio, in contrast to a male preponderance among peptic ulcer patients with normal renal function. Uraemic patients with ulcer were more likely to be pain-free, to present with haemorrhage, to have multiple ulcers and postbulbar duodenal ulcers, but were less likely to have H. pylori infection. Among uraemic subjects, the prevalence of H. pylori infection was similar whether or not peptic ulcer was present.

CONCLUSIONS

The prevalence of histological gastritis was lower in uraemic patients when compared with patients with functional dyspepsia and healthy volunteers. Peptic ulcers in uraemic subjects have different clinical characteristics from peptic ulcer in non-uraemic subjects.

Resveratrol, an antioxidant present in red wine, induces apoptosis in human promyelocytic leukemia (HL-60) cells

Resveratrol, a triphenolic stilbene present in grapes and other plants, has striking antioxidant and anti-inflammatory activities which have been considered to be responsible for the beneficial effects of red wine consumption on coronary heart disease. Recent studies reveal that resveratrol can inhibit each step of multistage carcinogenesis. However, the molecular mechanisms underlying anti-tumorigenic or chemopreventive activities of this phytochemical remain largely unknown. In the present work, we have found that resveratrol reduces viability and DNA synthesis capability of cultured human promyelocytic leukemia (HL-60) cells. The growth inhibitory and antiproliferative properties of resveratrol appear to be attributable to its induction of apoptotic cell death as determined by morphological and ultrastructural changes, internucleosomal DNA fragmentation, and increased proportion of the subdiploid cell population. Resveratrol treatment resulted in a gradual decrease in the expression of anti-apoptotic Bcl-2. These results, together with previous findings, suggest the cancer therapeutic as well as chemopreventive potential of resveratrol.

Reflux esophagitis patients in Singapore have motor and acid exposure abnormalities similar to patients in the Western hemisphere

OBJECTIVE

Endoscopic esophagitis is less common in the East than in the West. The reason for this is unknown. This study examines prospectively the relationship between endoscopic esophagitis and lower esophageal sphincter pressure, distal esophageal contractility, esophageal peristaltic performance, esophageal acid exposure, gastric acid output, and Helicobacter pylori (H. pylori) status in a consecutive series of Asian patients.

METHODS

Esophageal manometry and ambulatory pH monitoring were carried out in 48 patients with endoscopic esophagitis and 208 patients with symptoms suspicious of gastroesophageal reflux disease but without esophagitis. Gastric acid output and H. pylori serology were determined in 22 of the esophagitis group and 36 of the nonesophagitis group.

RESULTS

Compared to the nonesophagitis patients, esophagitis patients had a higher prevalence of hypotensive lower esophageal sphincter (49% vs 24%, p < 0.001), impaired esophageal contractility (45% vs 22%, p < 0.005), poor peristaltic performance (23% vs 12%, p < 0.05), and pathological acid reflux (48% vs 27%, p < 0.005). However, there was no difference in the two groups with respect to gastric acid output and H. pylori positivity.

CONCLUSIONS

Lower esophageal sphincter competence, esophageal peristaltic contractility, and esophageal acid exposure were important factors in the pathogenesis of reflux esophagitis--results identical to Western studies. Gastric acid output per se and H. pylori infection might not be responsible for susceptibility to esophagitis.

Standard oesophageal manometry in healthy adults in Singapore

Data on oesophageal manometry in normal subjects in the East are limited. The aim of this study was to define standard oesophageal pressure values in a group of healthy adults in Singapore. Standard oesophageal manometry was performed on 26 asymptomatic volunteers (12 males and 14 females, aged 19 to 34 years) using the water-perfused capillary system and stationary pull-through technique. Median (range) lower oesophageal sphincter pressure, distal oesophageal contractile amplitude, distal oesophageal contractile duration and distal oesophageal contractile velocity were 13.6 (8.0 to 32.0) mmHg, 93.0 (41.0 to 143.0) mmHg, 3.8 (3.2 to 5.3) s and 3.6 (2.2 to 4.6) cm/s respectively. They were similar in males and females except for distal oesophageal contractile velocity which was higher in males than females [4.0 (3.1 to 4.6) cm/s versus 3.2 (2.2 to 4.4) cm/s, P < 0.01]. They were also generally in line with published normal values from Western countries. The present study helps to establish standards for normal manometric findings, at least among the young adults, in this part of the world.

Prevalence of gastrointestinal symptoms in a multiracial Asian population, with particular reference to reflux-type symptoms

OBJECTIVE

Data on the epidemiology of chronic gastrointestinal symptoms in the East are limited. The aims of this study were to estimate the prevalence of chronic gastrointestinal symptoms in Singapore and to determine whether ethnic differences in the prevalence of these symptoms exist.

METHODS

A cross-sectional survey, using a reliable and valid questionnaire, was carried out in a race-stratified random sample of residents aged 21-95 yr (mean+/-SD, 40+/-1 yr) in a Singaporean town; 93% responded (n=696).

RESULTS

The ethnic-adjusted prevalence of chronic abdominal pain, frequent dyspepsia, irritable bowel syndrome, chronic constipation, chronic diarrhea, and frequent reflux were 5.7% (95% confidence interval [CI], 3.3-8.1), 7.9% (95% CI, 5.0-10.8), 2.3% (95% CI, 0.8-3.9), 3.9% (95% CI, 1.9-5.9), 4.5% (95% CI, 2.3-6.7), and 1.6% (95% CI, 0.6-2.6), respectively. There were no ethnic differences in the prevalence of any of these symptom categories except for reflux-type symptoms, which were more common among Indians (7.5%; 95% CI, 4.4-11.7) than Chinese (0.8%; 95% CI, 0.1-3.0) or Malays (3.0%; 95% CI, 1.26.1).

CONCLUSION

The prevalence of all types of chronic gastrointestinal symptoms in the general population of Singapore was low compared with those in the West. Chronic gastrointestinal symptoms were equally prevalent in the three major ethnic groups except for reflux-type symptoms, which were more common among Indians than Chinese or Malays.

Prevalence of gastrointestinal symptoms in a multiracial Asian population, with particular reference to reflux-type symptoms

OBJECTIVE

Data on the epidemiology of chronic gastrointestinal symptoms in the East are limited. The aims of this study were to estimate the prevalence of chronic gastrointestinal symptoms in Singapore and to determine whether ethnic differences in the prevalence of these symptoms exist.

METHODS

A cross-sectional survey, using a reliable and valid questionnaire, was carried out in a race-stratified random sample of residents aged 21-95 yr (mean+/-SD, 40+/-1 yr) in a Singaporean town; 93% responded (n=696).

RESULTS

The ethnic-adjusted prevalence of chronic abdominal pain, frequent dyspepsia, irritable bowel syndrome, chronic constipation, chronic diarrhea, and frequent reflux were 5.7% (95% confidence interval [CI], 3.3-8.1), 7.9% (95% CI, 5.0-10.8), 2.3% (95% CI, 0.8-3.9), 3.9% (95% CI, 1.9-5.9), 4.5% (95% CI, 2.3-6.7), and 1.6% (95% CI, 0.6-2.6), respectively. There were no ethnic differences in the prevalence of any of these symptom categories except for reflux-type symptoms, which were more common among Indians (7.5%; 95% CI, 4.4-11.7) than Chinese (0.8%; 95% CI, 0.1-3.0) or Malays (3.0%; 95% CI, 1.26.1).

CONCLUSION

The prevalence of all types of chronic gastrointestinal symptoms in the general population of Singapore was low compared with those in the West. Chronic gastrointestinal symptoms were equally prevalent in the three major ethnic groups except for reflux-type symptoms, which were more common among Indians than Chinese or Malays.

The effect of test duration on the sensitivity and specificity of ultra-rapid urease test for the detection of Helicobacter pylori infection

BACKGROUND

'Home made' ultra-rapid urease tests are used extensively in the Asia Pacific region. Data on the reliability of these 'home made' tests are limited.

AIMS

To evaluate the effect of test duration on the sensitivity and specificity of a self-prepared biopsy urease test for the detection of Helicobacter pylori.

METHODS

Using histology as the 'gold standard', the effect of test duration on the sensitivity and specificity of a self prepared urease test for the detection of H. pylori was evaluated in 411 consecutive patients undergoing upper gastrointestinal endoscopy.

RESULTS

Histology was positive for H. pylori in 217 of the 411 patients (52.8%). Within 24 hours of retrieving the specimen, 189 (87.1%) of the histology positives and 174 (89.7%) of the histology negatives were correctly identified by the urease test. Of the H. pylori positives, 72.0%, 81.0%, 89.9% and 100% were detected by the urease test within one minute, five minutes, three hours and 24 hours respectively. Thus, sensitivities of the urease test at one minute, five minutes, three hours and 24 hours were 62.7%, 70.5%, 78.3% and 87.1% respectively. Corresponding figures for the specificity were 93.8%, 93.3%, 92.3% and 89.7% respectively. Using a receiver-operating characteristic curve, an optimal combination of sensitivity and specificity was obtained when the urease test was read at 24 hours.

CONCLUSIONS

While the biopsy urease test was positive in most cases within a minute, better results could be obtained if the test continued to be read over a 24 hour period.

Protective action of capsaicin and chilli on haemorrhagic shock-induced gastric mucosal injury in the rat

Chilli and its pungent ingredient, capsaicin, have been shown to protect against experimental gastric mucosal injury induced by various necrotizing agents such as ethanol and aspirin and stress. We investigated the effect of capsaicin and long-term ingestion of chilli on haemorrhagic shock-induced gastric mucosal injury in the rat. Anaesthetized male Sprague-Dawley rats were subjected to haemorrhagic shock by withdrawing blood to reduce the mean arterial blood pressure to 30-40 mmHg with subsequent reinfusion of shed blood. This resulted in gastric mucosal injury with readily identifiable haemorrhagic lesions. Capsaicin (5 mg) administered prior to, but not after, haemorrhagic shock, significantly reduced the gastric mucosal injury in intact animals. Sensory ablation with capsaicin pretreatment (125 mg/kg bodyweight) abolished the gastroprotective effect afforded by capsaicin. Similarly, 4 week intake of chilli powder (360 mg daily) reduced the gastric mucosal injury in intact, but not in capsaicin-desensitized rats. Capsaicin and long-term chilli intake protected against haemorrhagic shock-induced gastric mucosal injury and the protection may be mediated by capsaicin-sensitive afferent neurons. Our studies are of potential significance in the context of stress ulcer disease in the human.

Symptomatic gastro-oesophageal reflux in pregnancy: a prospective study among Singaporean women

The present study was undertaken to estimate the prevalence and time course of reflux-type symptoms in Singaporean women and to determine if these symptoms were associated with nausea and vomiting of pregnancy. Consecutive pregnant women in the first trimester of pregnancy were recruited during attendance at an antenatal clinic in a Singapore teaching hospital. Each was interviewed, using a reliable questionnaire detailing demographic characteristics and symptoms, at four time points during the first, second and third trimesters of pregnancy and postpartum period. A total of 35 of 47 women originally enrolled (response rate 74%) completed the study. Heartburn alone, acid regurgitation alone and both heartburn and acid regurgitation were reported by 5.7, 17.1 and 17.1% of the subjects, respectively. Subjects who had these symptoms were more likely to suffer daily nausea and/or vomiting (78.6%) than those who did not (33.3%, P<0.05). In the majority of subjects, heartburn and/or acid regurgitation began in the first trimester (78.6%) and disappeared during the second trimester (71.4%). Nausea alone and in combination with vomiting similarly came on in the first trimester (100%) and subsided by the second trimester (85.7%) in the majority of the subjects studied. The reported prevalence of heartburn and/or acid regurgitation among Western pregnant women were 48-96% and 62%, respectively. Our data, therefore, showed that reflux-type symptoms were less common in Singaporean pregnant women. Reflux-type symptoms were related to nausea and vomiting, both in frequency and time pattern of onset and disappearance of symptoms. The association suggested either a common mechanism or a cause and effect relationship.