5-Aminosalicylic acid in patients with ulcerative colitis in remission: plasma levels after administration of a new rectal enema

Plasma levels of total 5-aminosalicylic acid (5-ASA) were determined after a single administration of 2 g and 4 g 5-ASA enemas to 6 patients with ulcerative colitis. The mean plasma levels and AUC values confirmed that the active substance is poorly absorbed by rectal route.

Endoscopic demonstration of loss of duodenal folds in the diagnosis of celiac disease

Among 873 patients undergoing upper gastrointestinal endoscopy for various reasons over a two-year period, four had a loss of Kerckring's folds in the descending duodenum. Endoscopic duodenal biopsy in all four patients revealed subtotal villous atrophy due to celiac disease. We undertook a prospective study to evaluate the extent to which this finding predicted celiac disease in 65 consecutive patients referred for intestinal biopsy. Duodenal folds were absent or markedly decreased in 15 of 17 patients with subtotal villous atrophy and in 8 of 48 patients with partial villous atrophy or normal duodenal mucosa, giving a sensitivity of 88 percent and a specificity of 83 percent for this endoscopic finding with respect to celiac disease. We recommend that all patients undergoing upper gastrointestinal endoscopy be examined for the loss or reduction of duodenal folds and, should this be found, that the examination include duodenal biopsy. The value of this procedure as an aid in the diagnosis of celiac disease should be particularly great in patients with minimal, transient, or unrelated symptoms.

Human lymphoblastoid interferon for the treatment of chronic hepatitis B. A randomized controlled trial

The aim of this study was to demonstrate whether interferon alone could affect the course of chronic hepatitis B. A total of 66 patients have so far been randomly assigned to receive six months of interferon therapy or no therapy; three patients in the interferon group and two in the control group have withdrawn from the study. Loss of hepatitis B virus-DNA and hepatitis B e antigen was significantly higher in the patients receiving interferon than in the control group; a significant loss of hepatitis B surface antigen was observed only in patients who received interferon. The time to alanine aminotransferase normalization was significantly shorter in patients receiving interferon than in the control group. These data encourage the use of interferon in treatment of chronic hepatitis B.

5-Aminosalicylic acid as enemas or suppositories in distal ulcerative colitis?

Thirty-nine patients with documented active distal proctitis (less than 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 be observed in terms of efficacy; however, it was the patients' opinion that treatment with suppositories was easier than that with enemas (p less than 0.01).

Morphological and hemodynamic changes in the portal venous system after distal splenorenal shunt: an ultrasound and pulsed Doppler study

We investigated a group of patients who underwent distal splenorenal shunt using high-resolution real-time equipment and a duplex scanner with the aims: (i) to evaluate the rate of visualization of shunt; (ii) to assess change in size in the portal vein, and (iii) to characterize the flow pattern in the splenic vein and to study flow direction and velocity in the portal vein, thus adding new data on the efficacy of this operation in maintaining hepatic perfusion. Real-time ultrasonography was performed in 29 patients before surgery, after 7 to 30 days and after 4 to 12 months. Direct visualization of the shunt was achieved in 53.5% of the patients. Mean caliber of the portal vein significantly decreased after the operation: preoperative = 1.52 +/- 0.32; after 7 to 30 days = 1.32 +/- 0.16 (p less than 0.001), and after 4 to 12 months = 0.99 +/- 0.19 (p less than 0.001). The overall postoperative incidence of portal thrombosis was 22.2%. Thirteen of these patients also underwent a postoperative (4 to 36 months) pulsed Doppler investigation. Flow towards anastomosis was demonstrated in the splenic vein in 11 patients, and in 7 cases, typical caval pulsatility was observed. Decreased hepatopetal flow in the portal vein was found in 10 of 13 patients. In two patients, no flow was detectable and in the other the flow was hepatofugal. On the basis of our data, we can affirm that pulsed Doppler investigation may provide useful data for the evaluation of shunt patency and preservation of a decreased portal hepatic perfusion in the majority of patients.

Urinary excretion rate of C-peptide in fed and fasted obese humans

The aim of the study was to evaluate the reliability of urinary excretion rate of C-peptide as a marker of B-cell function during fasting. Ten obese subjects of both sexes fasted for 5 days. Diurnal serum C-peptide was collected before and on the 5th day; morning serum samples (for glucose, insulin and C-peptide) and 12-h urine samples (7.00 to 19.00 h) were collected daily. Body weight decreased from 138.7 +/- 15.9 to 132.9 +/- 15.6 kg. Morning glucose, insulin (-40%) and C-peptide (-50%) fell significantly throughout the study. Mean diurnal C-peptide values were 2.19 +/- 0.69 nmol/l before and 0.60 +/- 0.19 nmol/l after fasting (P less than 0.0001) and its secretion rate was 909.4 +/- 297.9 and 244.4 +/- 83.9 nmol/12 h (P less than 0.005), respectively. Excretion rate of C-peptide fell progressively from basal (11.2 +/- 4.2 nmol/12 h) to a nadir value of 1.3 +/- 0.8 nmol/12 h (P less than 0.0005); similarly, the C-peptide to creatinine clearance ratio fell from 0.062 +/- 0.035 to 0.028 +/- 0.015 (P less than 0.05). These results indicate that fasting modifies renal metabolism of C-peptide thus creating several complications in the quantitative interpretation of urinary levels as an index of its secretion rate from the B-cell.

Weight loss and sex steroid metabolism in massively obese man

To evaluate the effect of weight loss and diet therapy on plasma sex hormone behavior in male obesity, 9 men with a BMI of 43.4 +/- 6.3 participated in an 8-week semistarvation program [whose energy content ranged from 320 to 500 k calorie/day (proteins 44 to 60 g and carbohydrates 54 to 81 g per day)] followed by a two-week hypocaloric (1000 k calorie/day) refeeding. In basal conditions, obese patients presented higher estrogen and lower dehydroepiandrosterone sulphate, testosterone (total and free) and sex-hormone binding globulin concentrations with respect to a group of control normal-weight subjects. Cumulative weight loss was 23.9 +/- 3.6 kg after semistarvation and 24.4 +/- 4.8 kg after refeeding (p = NS). A significant increase in testosterone, free testosterone and dehydroepiandrosterone sulfate was observed throughout the study, irrespective of dietary intake. A transient increase occurred in estrone levels while 17B-estradiol did not change. Gonadotropins and sex-hormone binding globulin values remained unaltered. No relationship was found between sex hormones and dietary energy content or composition. Daily urine free cortisol, which was used as a parameter of adrenal function, fell approximately 50% during semistarvation but returned to baseline values after refeeding. These results show that in massively obese patients weight loss per se may partially reverse sex hormone abnormalities but not sex-hormone binding globulin concentrations. It remains to be determined whether the return to "normal weight" can normalize steroid metabolic derangements in the obese man.

Impact of endoscopic ultrasonography on diagnosis and treatment of primary gastric lymphoma

Endoscopic ultrasonography (EUS) allows a visualization in vivo of the gastric wall. Five ultrasonic layers of different echogenicities are displayed; each corresponds to a precise anatomic structure. In gastric diseases this layering evidently changes. In 10 patients with suspected primary gastric lymphoma, EUS showed a characteristic thickening of the second, the second and third layers, or a diffuse, transmural thickening of the entire wall. A precise correlation between the longitudinal and depth infiltration observed at EUS and the surgical finding was seen in all patients. In three cases in which the preoperative bioptic diagnosis was erroneous (two gastritis and one carcinoma) EUS showed a characteristic echographic pattern for lymphoma, which was confirmed at surgery. There was agreement also, in EUS and surgical findings in all patients, about involvement of neighbor organs. It seems possible that in the future EUS could play an important role in detecting, staging, and planning treatment of lymphoma and other gastric tumors.

Oesophageal function before, during, and after healing of erosive oesophagitis

In order to investigate the relationship between oesophageal motor abnormalities and oesophagitis, we carried out four hour studies of oesophageal motility and 24 hour pH measurements in fasting and fed conditions in eight patients before, during (pH only), and after medical healing of erosive oesophagitis. Gastrooesophageal acid reflux decreased (ns) during the treatment, but tended to return to basal values at the end. Oesophageal body motility was unchanged after healing, while the lower oesophageal sphincter basal tone was significantly increased at the end of the study in the postcibal period. The results suggest that the impairment of the sphincter tone in reflux oesophagitis is secondary to the presence of the oesophageal lesions. Macroscopic healing is not paralleled by improved major pathogenic factors of the disease, however--that is, acid reflux and oesophageal body motility.

Pancreatic secretory response to ordinary meals: studies with pure pancreatic juice

We have studied the pancreatic secretory response to a normal meal in 5 subjects with an external drainage of the main pancreatic duct carried out after biliary tract surgery. Pancreatic juice was collected at 60-min intervals from 10 AM to 7 PM, starting 2 h before and ending 7 h after lunch, and was analyzed for volume, bicarbonate content, and protein content. Large doses of pancreatic extract were given between and during meals. Both bicarbonate and protein output increased rapidly after the beginning of the meal and the increase persisted, with minor fluctuations, for the entire 7-h study period between lunch and dinner. The peak postprandial bicarbonate and protein outputs were higher (on average by 20% and 26%, respectively) than bicarbonate and protein outputs induced by exogenous infusion of submaximal doses of secretin and cerulein. The profile and magnitude of the bicarbonate secretory pattern elicited by food were not substantially different from those of protein secretion. In an additional patient who had undergone a duodenocephalopancreatectomy plus two-thirds distal gastrectomy before the study, the pancreatic response to meals showed an initial phase characterized by an increase in pancreatic secretion during the first postprandial hour followed by a tendency to decrease in the subsequent 2 h, and a later phase (from the fourth postprandial hour to the end of the study) characterized by a more marked and more persistent increase in pancreatic secretion than occurred in the initial 3 h. These data indicate that (a) the pancreatic secretory response to ordinary meals is much more prolonged than is generally believed. The late phase of the response is not dependent on gastric emptying of food into the duodenum, but is probably related to the arrival of chyme in the distal ileum. (b) The pancreatic secretory response to a normal meal is quantitatively slightly higher than that produced by exogenous pancreatic stimulation with submaximal doses of secretin and cerulein. (c) The pattern of postprandial bicarbonate secretion is similar to that for protein.

Interdigestive gastroduodenal motor activity in subjects with increased gastric acid secretion

The interdigestive gastroduodenal motor activity was studied in 7 patients with active duodenal ulcer and increased gastric acid secretion, in 7 patients with hypersecretory gastroduodenitis and in 7 subjects with normal acid secretion, in whom the increase in acid secretion was obtained by means of the intravenous administration of an H2 agonist, Impromidine. The gastroduodenal motor activity was recorded manometrically for about 200-300 min in basal conditions to obtain at least two subsequent activity fronts of the migrating motor complex (MMC cycle). Only in subjects with normal acid secretion was Impromidine administered at a dose of 2 micrograms/kg/h for 150 min followed by a dose of 10 micrograms/kg/h for another period of 150 min, to obtain, respectively, a submaximal and a maximal secretory response. Patients with spontaneous acid hypersecretion, with or without peptic ulcer, showed a longer than normal MMC cycle with a shorter than normal percent of time occupied by phase III. This motor activity was similar to that recorded in normal subjects during the increase in acid secretion induced by the lowest dose of Impromidine, whereas during the highest dose the gastroduodenal MMC was disrupted and replaced by an irregular motor activity.

Pseudo-obstruction syndromes

Chronic intestinal pseudo-obstruction (CIP) is a clinical syndrome characterized by symptoms and signs of intestinal occlusion, in absence of any mechanical obstruction of the gut lumen. It causes impaired transit of intestinal contents and is determined by abnormalities of motor activity. The term CIP is used to indicate a heterogeneous group of disorders with many different pathogenic mechanisms. The defect in the regulation of intestinal transit can be at any level of motility control. Two main types of CIP are recognized, termed respectively myogenic (when smooth muscle cells are affected) and neurogenic (caused by abnormalities of extrinsic and/or intrinsic nervous supplies). Both types may be secondary to a variety of recognizable diseases or idiopathic. In myogenic CIP, intestinal transit is impaired because of lack of propulsive strength; in the neurogenic form, contractions are powerful but not sufficiently co-ordinated to propel intestinal contents aborally in an organized fashion. CIP belongs to the large and loosely defined group of digestive functional disorders. These disorders probably share common pathogenic mechanisms but with different expressiveness. The reasons why only some patients present recurrent symptomatological bouts resembling mechanical occlusion has not been clarified. This aspect is of great clinical relevance and deserves attention, as CIP patients, unlike other patients with severe functional disorders, may undergo repeated, useless and potentially dangerous operations. The diagnosis of CIP may be suggested by clinical features and is based on radiological, endoscopic, manometric, and histological findings. Recent technological improvements facilitate the recognition of this intriguing syndrome. In particular, manometric recording of the small bowel motility, which has long been considered an important research technique, can now also be regarded as a useful diagnostic tool.

Erythrocyte Na-K-ATPase membrane activity in obese patients fed over a long-term period with a very-low-calorie diet

In a search for the role of long-term hypocaloric feeding on the expression of the erythrocyte Na pump in obesity, we examined three groups of subjects. Group 1 consisted of 10 obese subjects who had been under treatment for a long period of time with a very-low-calorie diet (500 kcal/d) while group 2 consisted of 10 age-, sex-, and body mass index-matched obese subjects on their usual diet; in the third group, 12 normal-weight subjects on a free diet served as controls. There was no difference between the groups in the number of erythrocyte binding sites per cell. On the contrary, the Na-K-ATPase activity was significantly lower in the obese group 1 (0.35 +/- 0.09 mumol Pi x mg protein-1 x h-1) compared to that observed in the obese group 2 (0.42 +/- 0.07, P less than .05) and in control subjects (0.45 +/- 0.06, P less than .05). Sex, duration of hypocaloric feeding, and the amount of weight loss before the study in the obese group 1 seemed not to be related to the Na pump parameters. We conclude that long-term severe hypocaloric feeding may be a factor in altered erythrocyte Na-K-ATPase in obese individuals.

Efficacy of 5-aminosalicylic acid enemas versus hydrocortisone enemas in ulcerative colitis

A controlled trial has been carried out in order to compare the efficacy of enemas containing a high dosage of 5-ASA (4 g) versus enemas containing hydrocortisone 100 mg. The trial was conducted on 86 patients, 44 of whom received 5-ASA and 42 received hydrocortisone. The results were favorable in terms of clinical, sigmoidoscopic, and histologic criteria for 5-ASA treatment. Other aspects have been investigated, such as retrograde spread of enemas which have been shown to reach the left colon. No nephrotoxicity was detected. The long term experience confirmed the preliminary positive results.

Primary gastric lymphoma versus gastric carcinoma: endoscopic US evaluation

Endoscopic ultrasonography (US) enables high-resolution imaging of the stomach and can demonstrate the different layers of the gastric wall. It has therefore been proposed for use in evaluating the extension of gastric neoplasms. It was performed in nine patients with primary gastric non-Hodgkin lymphoma and in 36 with gastric carcinoma. The US and pathologic findings were correlated in three surgical specimens of gastric lymphoma. Three different US patterns were found in gastric lymphomas: a polypoid pattern (two cases), localized (two cases) or extended (five cases) hypoechoic infiltration, and thickening with superficial ulcerations. Infiltration was confined to the second and third layers of the gastric wall in six cases and was transmural in three. The study of the gastric lymphoma specimens confirmed the accuracy of US in demonstrating the extent of infiltration. Gastric carcinomas had a more echogenic pattern and a different trend of diffusion, with no extended longitudinal hypoechoic infiltration of the superficial layers or extended hypoechoic transmural infiltration.

Insulin as a factor of increased androgen production in women with obesity and polycystic ovaries

To evaluate the possible role of moderate hyperinsulinemia on abnormal androgen secretion, we examined 4 age and weight-matched groups of obese subjects: 2 groups of women with normal menses whose fasting insulin (IRI) levels were less than or equal to 20 microU/ml (OB-I) or greater than or equal to 40 microU/ml (OB-I) and 2 groups of women with polycystic ovaries who were similarly grouped. All subjects underwent an oral glucose tolerance test, blood sex hormone determination and multiple LH determinations. Compared to OB, OB-PCO women showed significantly higher values of LH, androgen and estrogen concentrations. OB-I and OB-II showed similar hormonal patterns. On the contrary, OB-PCO-II presented significantly (p less than 0.05) higher androstenedione concentrations (348.7 +/- 129.9 ng/dl) (m +/- SD) than OB-PCO-I women (237.0 +/- 73.7 ng/dl). These differences were evident despite similar plasma LH concentrations. In conclusion, these results suggest that insulin may be a factor amplifying LH-dependent androgen secretion in hyperandrogenized women with obesity and PCO.

Omeprazole vs. ranitidine in the short-term treatment of duodenal ulcer: an Italian multicenter study

A double-blind, double-dummy, randomized Italian multicenter trial was carried out to compare the efficacy and safety of omeprazole 20 mg in the morning and ranitidine 150 mg b.i.d. in short-term treatment of acute duodenal ulcer. One hundred and twenty-one patients (61 in the omeprazole and 60 in the ranitidine group) with endoscopically proven active duodenal ulcer, completed the study. The healing rates after 2, 4 and 6 weeks were 66, 97 and 100%, respectively, with omeprazole and 53, 85 and 92%, respectively, with ranitidine. The difference was statistically significant (p less than 0.05) at weeks 4 and 6. Night and day pain were markedly reduced during both treatments, as also antacid consumption. Both drugs were well tolerated, and the adverse events were infrequent and moderate. In our experience, omeprazole 20 mg once daily seems to be superior to ranitidine 150 mg b.i.d. in the short-term treatment of duodenal ulcer.

Effect of somatostatin 14 on pure human pancreatic secretion

While it is well known that large doses of somatostatin inhibit human pancreatic enzyme secretion, it is still unknown whether low doses are also effective and whether the peptide is able to inhibit bicarbonate production. Eight subjects with external transduodenal drainage of the main pancreatic duct performed after biliary tract surgery were studied. Somatostatin was infused at progressively increasing rates of 0.05, 0.15, 0.45, and 1.35 micrograms/kg/hr, for 30 min/dose, during pancreatic stimulation with secretin, 25 ng/kg/hr, and cerulein, 10 ng/kg/hr. Somatostatin, at the dose of 0.05 microgram/kg/hr (shown to produce blood levels similar to those measured after a meal) did not affect pancreatic secretion in any of the subjects. The successive three higher doses caused a significant and dose-dependent inhibition of protein concentration and output and of bicarbonate output. Bicarbonate concentration was slightly but significantly reduced only by the two highest doses of somatostatin. At each dose level, the inhibition of protein output was much more marked than the inhibition of bicarbonate output. The maximal inhibition of protein output (at 1.35 micrograms/kg/hr somatostatin) was 73.9 +/- 5.4%, and that of bicarbonate output was 55.9 +/- 6.4%. The results demonstrate that: (1) the administration of somatostatin at a low dose level does not affect human exocrine pancreatic secretion, at least under the experimental conditions of this study; and (2) the administration of larger doses of somatostatin inhibits pancreatic secretion of both protein and bicarbonate dose-dependently. The inhibitory effect on protein output is significantly greater than that on water and bicarbonate production.

A population study on the prevalence of gallstone disease: the Sirmione Study

The prevalence of gallstone disease (cholelithiasis and previous cholecystectomy for gallstones) in the population of the town of Sirmione, Italy, examined by ultrasonography, was 6.7% in men and 14.6% in women, ranging from 18 to 65 yr of age (overall prevalence = 11%). The prevalence of cholelithiasis in the same age span was 6.9% (4.5% in men and 8.9% in women). Prevalence of cholelithiasis increased with age in both sexes. Twenty-two percent of gallstone subjects suffered from biliary pain vs. 2% of subjects without gallstones. No difference was observed in the frequency of nonspecific symptoms between subjects with and without gallstones. Of the 132 gallstone subjects, 108 (82%) were not aware of having gallstones prior to the study. Prevalence of gallstone disease was found to be higher in obese and hypertriglyceridemic subjects and to increase with the number of pregnancies.

Optimal nutritional indexes in gastroenterology

Malnutrition in gastrointestinal disease can result from several pathogenetic mechanisms. The resulting clinical and laboratory features of malnutrition vary according to the specific pathogenetic factors involved. Many of the causes of malnutrition in gastroenterology are similar to those found in other acute and chronic diseases. However, certain disorders, specific to gastroenterology, may alter nutritional indices independent of the usual causes of malnutrition. These include small bowel bacterial overgrowth and protein-losing enteropathy. The impact of these disorders on the indexes of nutritional status is discussed.

Serum pancreatic enzyme behavior during the course of acute pancreatitis

The variations of serum levels of amylase, pancreatic isoamylase, lipase, trypsinogen, and elastase 1 were evaluated in 21 patients with acute pancreatitis. The patients were studied for a mean period of 7 consecutive days (range 5-12 days) after admission to the hospital. On the day of onset of acute pancreatitis, all enzyme levels were abnormally high; pancreatic isoamylase showed the greatest increase compared with its upper normal limit, whereas the increase increment for elastase 1 was the lowest. Subsequently, all enzyme levels except elastase 1 decreased in a parallel fashion. On the eighth day of the study only elastase 1 levels were above normal values in all patients examined, while abnormally high values of lipase were found in 85% of the patients, trypsinogen in 58% of the patients, pancreatic isoamylase in 43%, and total amylase in 23%. These results indicate that, for the early diagnosis of acute pancreatitis, the determination of any of these enzymes is equally efficient, but that elastase 1 is the most sensitive marker of acute pancreatic damage in later stages of the disease.

Short-term treatment of reflux oesophagitis with ranitidine 300 mg nocte. Italian multicentre study

A multicentre study involving 9 Italian institutions was carried out to compare the efficacy and safety of ranitidine 150 mg b.i.d. and ranitidine 300 mg nocte in the treatment of reflux oesophagitis. 117 patients with histologically proven oesophagitis were randomly allocated to two comparable treatment groups. Efficacy and reliability were evaluated by clinical and laboratory tests at the beginning of the study, and at 3 and 6 weeks; endoscopy and biopsies were performed at the beginning and at 6 weeks. Treatment with ranitidine for 6 weeks led to total disappearance of gastro-oesophageal reflux symptoms in 60% of patients, with percentages of partial improvement varying between 85% and 95% of cases. Improvement in the results of endoscopic examination was 85%, of which 55% were cured. Microscopic examination revealed an improvement of 36% and 44%, with a cure rate of 18% and 26% respectively. With regard neither to the regression of symptoms nor to the macroscopic and microscopic inflammation of the oesophageal mucosa did statistical examination show significant differences in the therapeutic efficacy of ranitidine 150 mg b.i.d. or 300 mg nocte for treatment of reflux oesophagitis.

Urinary zinc excretion in Crohn's disease

In order to study the reliability of urinary zinc levels as an index of zinc metabolism and status in Crohn's disease, we evaluated plasma and urinary zinc concentrations, urinary 3-methylhistidine excretion, and Crohn's disease activity index (CDAI) in 42 patients affected by Crohn's disease. Plasma zinc correlated directly with albuminemia (P = 0.01) and inversely with CDAI (P = 0.001). Urinary zinc excretion correlated with urinary 3-methylhistidine (P = 0.001) and plasma zinc levels (P = 0.01), and inversely with CDAI (P = 0.05). However, from multiple regression analysis, it was found that zincemia is influenced by CDAI and not by albumin, whereas zincuria is related to urinary 3-methylhistidine and plasma zinc, and not to CDAI. Our conclusion is that, in Crohn's disease, zincuria can be an index of zinc status when used together with measurements of lean body mass and turnover and factors influencing plasma ultrafiltrable zinc fraction.

Effect of chronic administration of cisapride on gastric emptying of a solid meal and on dyspeptic symptoms in patients with idiopathic gastroparesis

In a double blind crossover comparison with placebo, the effects of cisapride (10 mg tid for two weeks), a non-antidopaminergic gastrointestinal prokinetic drug, on gastric emptying times and on symptoms were evaluated in 12 patients with chronic idiopathic dyspepsia and gastroparesis. Gastric emptying was studied by a radioisotopic gamma camera technique. The test meal was labelled in the solid component (99mTc-sulphur colloid infiltrated chicken liver). Nine symptoms (nausea, belching, regurgitations, vomiting, postprandial drowsiness, early satiety, epigastric pain or burning, heartburn) were graded weekly on a questionnaire. Cisapride was significantly more effective than placebo in shortening the t1/2 of gastric emptying (p2 = 0.04), but no significant difference was observed between the two treatments with regard to the improvement of total symptom score (p2 = 0.09). No side effects were reported during the study.

Relationship between morphological changes detected by ultrasonography and pancreatic exocrine function in chronic pancreatitis

We have studied the degree of pancreatic secretory alterations assessed by secretin-cerulein test (S-C) in relation to various morphological changes detected by real-time ultrasonography (US) in 42 patients affected by chronic pancreatitis. Exocrine insufficiency was found in 41 patients (97.6%), while morphological alterations were detected in 32 (76.1%). In the 10 patients with normal US, a mild or moderate exocrine insufficiency was present. Significant negative linear correlations of decreasing volumes of duodenal aspirate (r = 0.528, p less than 0.001) and output of bicarbonate (r = 0.635, p less than 0.001), lipase (r = 0.583, p less than 0.001), and chymotrypsin (r = 0.592, p less than 0.001) were found with increasing ultrasonographic alterations. However, a wide overlap was found in the secretory behavior in the various categories of change as determined by ultrasound. Hence, the attempt to predict exocrine function on the basis of morphological alterations proved unsuccessful.

Effect of albumin on taurocholate uptake kinetics in rat liver

Isolated rat livers were perfused in a single pass with increasing doses of taurocholate with and without albumin in the perfusion media. The kinetics of taurocholate uptake were thus evaluated. In all the experiments, taurocholate uptake showed Michaelis-Menten kinetics. Increasing the albumin concentration in the medium resulted in an increase in the Km, without effect on the Vmax.. When taurocholate and albumin were kept constant (20:1 molar ratio), the Vmax. was significantly lower than in the other experiments. These data suggest that taurocholate uptake shows saturation in the absence of albumin and that albumin reduces taurocholate uptake.

Sonographic evaluation of the portal venous system after elective endoscopic sclerotherapy of esophageal varices

In order to evaluate possible changes in the portal venous system after endoscopic sclerosis of esophageal varices, 25 cirrhotic patients underwent abdominal ultrasonography before the first session of sclerotherapy and after eradication of esophageal varices had been achieved. The caliber of the portal, splenic, and superior mesenteric veins was measured sonographically in each case. Sonographic results were compared statistically before and after sclerotherapy. Neither evidence of significant variations in the caliber of the portal veins nor thrombotic obliteration was seen. These results support the view that sclerotherapy has no significant negative side effects on the portal venous system.

The sonographic appearance of the normal gastric wall: an in vitro study

In order to evaluate the real number and anatomical correspondence of the ultrasonographically recognizable layers within the gastric wall, we used a high frequency (7.5 MHz) rotating transducer to examine five surgical specimens of the stomach suspended in a water bath. Five layers were always clearly distinguishable within the gastric wall, whose thickness was 3-6 mm. Fine needles and lancets were localized at the level of the 3rd hyperechoic layer when inserted in the submucosa and in the 4th hypoechoic layer when inserted in the muscolaris propria. Thin echogenic bands were always displayed on both sides of other homogeneous tissues (spleen, myometrium) suspended in water. On the basis of these findings and also taking in account the physical laws of ultrasound interactions with tissues, we conclude that the 1st and the 5th hyperechoic layers are partially generated by ultrasound reflection at the interface liquid/wall. The 2nd hypoechoic layer corresponds to the deepest part of the mucosa; the 3rd hyperechoic to the submucosa and the submucosa/muscularis propria interface and the 4th hypoechoic layer to the muscularis propria.

[Effect of tiropramide on solid gastric emptying time in man]

The influence of Thyropramide, a recently developed spasmolytic on the gastric emptying times of a solid meal was assessed in 10 healthy subjects aged 23-54. Thyropramide (300 mg per diem for 3 days per os) does not significantly modify gastric emptying time compared to the placebo though a slight average increase in T 1/2 was noted. No side effects were noted during the study. Thyropramide therefore appears to have a spasmolytic effect on the large intestine without in any way influence the stomach either proximally or distally.

A double-blind controlled trial of ranitidine 300 mg nocte and ranitidine 150 mg b.i.d. in the short-term treatment of gastric ulcer

A multi-center study was carried out to compare the healing rates of ranitidine 300 mg nocte and 150 mg b.i.d. in the short-term treatment of gastric ulcers and to assess the side-effect liability of ranitidine 300 mg given in a single daily dose. Forty-five outpatients suffering from endoscopically and bioptically proven uncomplicated benign gastric ulcer were selected for the study. The patients were treated, for 4 weeks, on the basis of a double-blind randomized design. An endoscopic examination was repeated within 4 days after the end of the treatments. The patients who did not demonstrate complete healing were treated for an additional 4-week period. Clinical controls were performed to evaluate symptoms, antacid consumption, compliance with trial tablet consumption; hematological and biochemical tests were also carried out at the end of the 4 and 8-week periods. No differences were observed between the healing rate induced by 300 mg nocte and 150 mg b.i.d., after 4 weeks of treatment (76% and 79% respectively) and after 8 weeks (100% in both groups). Similar results were obtained as far as symptoms, antacid consumption and compliance are concerned. Neither treatment regimen induced appreciable side-effects.

The role of colloidal bismuth subcitrate in the short-term treatment of duodenal ulcer

Colloidal bismuth subcitrate (CBS) is a drug used in the treatment of duodenal ulcer; it acts mainly by increasing mucosal resistance against endoluminal aggressive agents, without inhibiting gastric secretion. In previous clinical trials, CBS solution induced healing rates significantly higher than placebo and similar to those observed with cimetidine. In spite of these promising results, the drug has never been widely employed, mainly because of its unpleasant taste, which greatly reduced patient compliance. For this reason, chewing tablets have been introduced. CBS tablets have been reported to induce healing rates significantly higher than placebo and similar to those obtained with CBS solution, cimetidine, and ranitidine. CBS may therefore represent an important alternative to antisecretory drugs in the therapy of duodenal ulcer patients.

The evolution of anti-ulcer therapy with cimetidine. Is a single large nocturnal dose of cimetidine the right therapy for duodenal ulcer?

Peptic ulcer results from the prevalence of agents causing endoluminal lesions over the defence mechanisms of the mucosa of the upper GI tract. Particularly, in the case of duodenal ulcer, the pathogenetic relevance of non-buffered acid secretion of the early nighttime period has been emphasized. This is indeed confirmed by the fact that a single night dose of 800 mg cimetidine has apparently been proved able--in numerous controlled clinical trials--to provide results that are similar to those obtained with the classic dose of 1 g daily or 400 mg twice daily. Our centre carried out a crossover double-blind controlled trial aimed at evaluating titrable acidity and pH during the 24-h period in seven patients with active duodenal ulcer. The single nighttime dose of cimetidine resulted in a significant and long-lasting inhibition of acid secretion during the entire night. During the day, secretory values returned to levels similar to those obtained with placebo, hence allowing normal digestive functions.

[Famotidine versus placebo in prevention of the recurrence of duodenal ulcer disease. A multicenter study in Germany, Austria and Italy]

The aim of this study was to gain experience concerning efficacy and safety of famotidine, the new H2-receptor antagonist, for the maintenance of duodenal ulcer disease. 344 patients whose acute duodenal ulceration had recently been healed under famotidine or ranitidine were recruited for a year maintenance treatment with 20 mg bedtime dose of famotidine or placebo. 167 patients were treated with famotidine over 6 and 52 over 12 months. The corresponding numbers in the placebo control were 177 and 21. A life table method of analyses showed that the ulcer relapse rate was consistently and significantly (p less than 0.01) lower on famotidine than on placebo after 6 months (26% [43/167] versus 55% [98/177]). Of the 52 patients treated with 20 mg famotidine at night for further 6 months 7 (14%) developed an ulcer relapse. Of the 21 patients treated for further 6 months with placebo 5 (24%) showed an acute ulcer crater at endoscopy. Famotidine was well tolerated in the longterm therapy. The results confirm the efficacy and safety of famotidine in the prevention of duodenal ulcer relapse for at least 6 months.

Value of serum determinations for prediction of increased ursodeoxycholic and chenodeoxycholic levels in bile

The correlation between biliary and serum levels of ursodeoxycholic and chenodeoxycholic acids was studied in a double-blind controlled manner in 39 patients before and during treatment with ursodeoxycholic acid, 800 mg/day; ursodeoxycholic acid, 400 mg/day; chenodeoxycholic acid, 750 mg/day; chenodeoxycholic acid, 375 mg/day; and placebo, respectively. On a total of 74 occasions, fasting duodenal bile and venous blood samples were obtained simultaneously. Biliary bile acid composition was determined by gas-liquid chromatography and serum ursodeoxycholic and chenodeoxycholic acid concentrations by radioimmunoassays. There was a much closer correlation between the biliary and serum levels of ursodeoxycholic acid (r = 0.8184, P less than 0.001) than between those of chenodeoxycholic acid (r = 0.4707, P less than 0.01). In contrast to serum chenodeoxycholic, which showed many overlaps between pre- and posttreatment values, serum ursodeoxycholic acid proved to be a very sensitive, specific, and convenient means of predicting the presence of increased levels of ursodeoxycholic acid in the enterohepatic cycle.

Effect of chemically defined formula diets on pancreatic mass in the rat

To establish the effect of chemically defined formula diets on pancreatic mass, 58 male Wistar rats, weighing approximately 200 g, were fed orally one of the following diets for 20 days: standard diet; partially hydrolyzed diet; elemental diet. The diets were isocaloric and provided 73 cal/day per rat. At the end of the experiment, the rats were killed and pancreas removed to assess wet weight and DNA and RNA content. Compared to the controls, the elemental diet caused a reduction in pancreatic wet weight (p less than 0.005), pancreatic DNA (p less than 0.001), and RNA content (p less than 0.001). In the group fed partially hydrolyzed diet, only pancreatic DNA content showed an highly significant reduction when compared with the reference group (p less than 0.001), whereas the value of RNA failed to reach the statistical significance. We found an increase of the ratio mg RNA/mg DNA in the partially hydrolyzed and elemental diet groups. These results suggest that long-term nutrition with the partially hydrolyzed diet, and more strongly with the elemental diet, may induce pancreatic hypoplasia.

[Accelerated healing of ulcus ventriculi by a single evening dose of famotidine. Results of an Austrian-German-Italian multicenter study]

An 8 week, double-blind randomized, placebo-controlled multicenter trial was conducted in Austria, Germany and Italy to determine whether famotidine would speed healing and relief of symptoms in patients with benign gastric ulcer. Of the 131 patients who completed the trial, 66 received 40 mg famotidine in the evening and 65 placebo. At 4, 6, and 8 weeks after entry, ulcers had healed in a higher percentage of patients treated with famotidine than of those treated with placebo (47%, 70%, 91% vs 32%, 49%, 61%). In the famotidine group healing had occurred significantly more often after 6 and 8 weeks (p less than 0.05 and p less than 0.01 respectively). Famotidine was superior to placebo in relieving ulcer symptoms. The proportion of patients receiving additional antacid therapy was significantly lower in the famotidine group. The findings suggest that the new H2-receptor antagonist famotidine significantly speeds the healing of benign gastric ulcers in a single evening dose.

Oesophageal motor events at the occurrence of acid reflux and during endogenous acid exposure in healthy subjects and in patients with oesophagitis

In order to assess the oesophageal motor events associated with the occurrence of gastro-oesophageal acid reflux and those during endogenous acid exposure, we studied six healthy subjects and nine patients with symptoms and lesions of reflux oesophagitis. In the case of each subject simultaneous pressure and pH measurements of the distal oesophagus were taken both in fasting conditions and after a standardised balanced meal. Reflux episodes occurred in the absence of a lower oesophageal sphincter relaxation (34.3%, 17.7%) or in the presence of a relaxation associated (34.2%, 30.8%) or unassociated (31.5%, 51.5%) with a peristaltic sequence, in the controls and patients respectively. No significant differences were found between the two groups. During endogenous acid perfusion the distal oesophagus showed mainly a peristaltic motor activity, but the mean hourly number of peristaltic sequences was significantly lower in the patients than in the controls (33.5 +/- 27.2 vs 81.5 +/- 3.2, p less than 0.01). Our results show that the mechanisms of reflux are similar in controls and in patients, while the peristaltic frequency is reduced in the latter. This motor failure may be responsible for the increased reflux duration observed in patients with oesophagitis.

Depression and gastrointestinal illness: the joint use of biological and clinical criteria

Occurrence and characteristics of depression were investigated in 37 consecutive patients suffering from gastrointestinal illness. More than 40% of patients with an organic digestive disease and about a quarter of those with functional gastroenterological complaints were found to suffer from a major depressive disorder according to DSM-III criteria. The dexamethasone suppression test--a laboratory marker of the endogenous depressive state--supported clinical diagnosis in several cases, yet its routine use to screen depression is not warranted because of its poor specificity. The results should alert the physician to include clinical and biological criteria for depression in the diagnostic work-up for gastrointestinal illness.

Transfer factor for the treatment of HBsAg-positive chronic active hepatitis

Transfer factor was obtained from four patients having recovered from acute type-B viral hepatitis. It was replicated in vitro using the LDV/7 lymphoblastoid cell line. This in vitro-produced transfer factor specific for hepatitis B (TFdL-H) was administered to 10 randomly selected patients with biochemically and histologically proven HBsAg-positive chronic active hepatitis (CAH) at 15-day intervals over a 6-month period. In three out of four initially HBeAg-positive patients, anti-HBe antibodies appeared when the HBeAg disappeared. In one of these patients and in two other HBsAg-positive patients, the appearance of anti-HBs antibodies was noted. The improvement in several biochemical parameters of the TFdL-H patients was statistically significant when compared with those of another group of 10 randomly selected untreated CAH patients. Liver biopsies in six out of eight treated patients showed a histological improvement at the end of the treatment. These results suggest that TFdL-H may be used with beneficial effect for the treatment of HBsAg-positive CAH.

Candida albicans infection of gastric ulcer frequency and correlation with medical treatment. Results of a multicenter study

This paper reports the results of a multicenter prospective study of 188 consecutive patients affected by gastric ulcer, verified by endoscopy, in whom the frequency of a mycotic infection of the lesion was evaluated as well as the eventual influence of such pathology on the efficiency of medical treatment, the healing rate, and the healing time. A mycotic infection, defined as penetration of the periulcerous mucosa by the fungi, was found in only 13 patients (6.9%). No significant differences were found in the healing rate and healing time among these patients treated with H2-receptor antagonists and a control group of 43 matched gastric ulcer patients treated in the same period with the same therapy. It would appear from the data that mycotic infections of the gastric ulcer do not modify the efficiency of medical treatment.