[How safe is sedation in gastrointestinal endoscopy? A multicentre analysis of 388,404 endoscopies and analysis of data from prospective registries of complications managed by members of the Working Group of Leading Hospital Gastroenterologists (ALGK)]. / Wie sicher ist die Sedierung in der gastrointestinalen Endoskopie? Eine multizentrische Auswertung von 388 404 Endoskopien und Auswertung der Daten aus prospektiv geführten Komplikationsregistern von Mitgliedern der Arbeitsgemeinschaft leitender Gastroenterologen im Krankenhaus (ALGK).

BACKGROUND: Gastrointestinal endoscopies are increasingly being carried out with sedation. All of the drugs used for sedation are associated with a certain risk of complications. Data currently available on sedation-associated morbidity and mortality rates are limited and in most cases have substantial methodological limitations. The aim of this study was to record severe sedation-associated complications in a large number of gastrointestinal endoscopies. METHODS: Data on severe sedation-associated complications were collected on a multicentre basis from prospectively recorded registries of complications in the participating hospitals (median documentation period 27 months, range 9 - 129 months). RESULTS: Data for 388,404 endoscopies from 15 departments were included in the study. Severe sedation-associated complications occurred in 57 patients (0.01 %). Forty-one percent of the complications and 50 % of all complications with a fatal outcome (10/20 patients) occurred during emergency endoscopies. In addition, it was found that 95 % of the complications and 100 % of all fatal complications affected patients in ASA class ≥ 3. CONCLUSIONS: Including nearly 400,000 endoscopies, this study represents the largest prospective, multicenter record of the complications of sedation worldwide. The analysis shows that sedation is carried out safely in gastrointestinal endoscopy. The morbidity and mortality rates are much lower than previously reported in the literature in similar groups of patients. Risk factors for the occurrence of serious complications include emergency examinations and patients in ASA class ≥ 3.

[Nutritional therapy in gastrointestinal diseases. Diets--necessary or superfluous?]. / Ernährungstherapie bei Magen-Darm-Erkrankungen. Diäten--nützlich oder überflüssig?

Diets form a part of the treatment concept in numerous gastrointestinal diseases. Their effectiveness, however, varies considerably from one disease to another. Thus, for example, diet is of decisive importance in celiac disease and lactose intolerance. In contrast, dietary measures are ineffective in the treatment of gallstones, and uncertain as a prophylactic measure against biliary colic. While dietetic measures are an important temporary measure in acute pancreatitis, in chronic pancreatitis such an approach is often not complied with, since it includes abstinence from alcohol. In chronic inflammatory bowel disease, diet can ameliorate a number of complications, although it leaves the pathological process itself unaffected. High-fiber diet is, for the most part, ineffective in patients with irritable bowel syndrome. The present article discusses the benefits of dietary measures in a number of gastroenterological disorders.

[Improving prognosis of chronic liver diseases with specific nutrition]. / Chronische Lebererkrankungen Prognose verbessern mit gezielter Ernährung.

A sensible diet is capable of reducing the complications of chronic liver disease and improving the patient's prognosis. In patients with compensated liver disease, adequate nutrition should be ensured, but specific therapeutic measures are not generally required. Patients with decompensated liver disease often have deficient nutrition or malnutrition. In these patients specific dietary measures make good sense.

Bile and acid reflux in long and short segment Barrett's esophagus, and in reflux disease.

Gastroesophageal acid reflux (GER) is the primary risk factor for gastroesophageal reflux disease (GERD). In long segment Barrett's esophagus (LSBE) duodenogastroesophageal reflux (DGER) parallels acid reflux. The role of GER and DGER in short segment Barrett's esophagus (SSBE) remains to be determined. The aim of the present prospective study was to investigate the esophageal bile and acid reflux in patients with LSBE, SSBE and patients with GERD. Three groups of patients were studied: Patients with LSBE (n = 12), SSBE (n = 20) and patients with GERD without intestinal metaplasia (n = 33). Subjects underwent esophageal manometry and simultaneous 24-h pH and bile monitoring (Bilitec 2000). The thresholds for GER and DGER were a deMeester score > 14.7 and an absorbance value > 0.2 for 10.9% of total period, respectively. GER did not differ between the groups (p > 0.05). However, DGER differed between patients with LSBE, SSBE and GERD (14.7 vs 2.1 vs 2.1, respectively; p < 0.05). H. pylori status did not influence GER and DGER significantly. In contrast to patients with LSBE the DGER does not seem to play an important role in patients with SSBE and patients with GERD. This result indicates a different etiopathology of both long and short segment Barrett's esophagus.

[Peptic ulcer in the elderly--endoscopy in suspected ulcer. Therapy always includes proton pump inhibitor]. / Peptisches Ulkus im Alter--bei Verdacht endoskopieren. Zur Therapie gehören in jedem Fall Protonenpumpenhemmer.

In the elderly patient, peptic ulcer disease is associated with increased morbidity and mortality. Abdominal pain is often absent, and the first sign is blood in the stools. The major risk factors are infection with Helicobacter pylori and the use of non-steroidal antiinflammatory drugs (NSAIDs). Endoscopic and medical treatment of peptic ulcer is independent of the age. The use of proton pump inhibitors is the treatment of choice. In the event of an infection with H. pylori, eradication treatment is usually carried out. Currently, however, H. pylori eradication is not recommended in patients with NSAID-associated ulcers; if possible, the NSAIDs should be discontinued. The development of a new generation of NSAIDs holds out the promise of a marked reduction in gastrointestinal side effects.

Pantoprazole suppresses Helicobacter pylori without affecting cure.

BACKGROUND: Short-term, low-dose triple regimens composed of proton-pump inhibitors (PPI) and two antibiotics are the current gold standard therapy for cure of Helicobacter pylori infection. To date, the effect of PPI pretreatment on eradication outcome is not known. The aim of this study was to evaluate the influence of pretreatment with pantoprazole on the efficacy of an ensuing triple therapy. METHODS: In this open, randomized, monocenter, parallel group comparison, 107 patients with duodenal ulcer or functional dyspepsia were assigned to receive one of the following treatment regimens: a 7-day triple therapy with pantoprazole, 40 mg bid; clarithromycin, 250 mg bid; and metronidazole, 400 mg bid, which was either preceded or followed by a 7-day therapy with pantoprazole, 40 mg (P-PCM or PCM-P). Assessment of H. pylori status was performed by a biopsy urease test and 13C urea breath test at the initial visit and 13C urea breath test at all follow-up visits. RESULTS: The 7-day pantoprazole pretreatment resulted in a significant decline of the delta values of the 13C urea breath test. H. pylori infection was cured in 47 of 52 intention-to-treat patients of the P-PCM group (90%; 95% confidence interval, 79-97%) and in 46 of 53 of the PCM-P group (87%; 95% confidence interval, 75-95%). CONCLUSIONS: Pretreatment with pantoprazole suppresses H. pylori but does not impair the efficacy of a consecutive short-term, low-dose triple therapy.

13C mixed-triglyceride breath test: isotope selective non-dispersive infrared spectrometry in comparison with isotope ratio mass spectrometry in volunteers and patients with chronic pancreatitis.

BACKGROUND: The 13C mixed-triglyceride breath test (MTB) has been proposed for the non-invasive assessment of duodenal pancreatic lipase activity. Until now, stable isotope analysis of CO2 of the MTB has been carried out with isotope ratio mass spectrometry (IRMS). The aim of the present study was to compare MTB results by using the new non-dispersive infrared spectrometry (NDIRS) and the IRMS. METHODS: Ten healthy volunteers and 10 patients with chronic pancreatitis and exocrine insufficiency were studied. After an overnight fast each subject received a test meal containing 250 mg 1,3 distearyl, 2[13C] octanoyl glycerol. Breath samples were taken at base line and at 30-min intervals over a period of 6 h postprandially. The 13C/12C ratio was determined in each breath sample by NDIRS and CF-IRMS as delta values. Results were expressed as delta over base line (DOB (per 1000)) and as cumulative percentage dose of 13C recovered (cPDR (%)). Correlations between IRMS and NDIRS were tested by linear regression analysis. For measuring agreement an Altman-Bland plot was performed. RESULTS: A linear correlation was found (DOB: y = 0.645 +/- 0.040 x + 1.496 +/- 0.089, r = 0.70, P < 0.0001; cPDR: y = 1.269 +/- 0.031 x + 2.010 +/- 0.353, r = 0.93, P < 0.0001). For DOB the mean difference (d) was 1.0/1000, and the standard deviation (s) of the difference was 1.3/1000. The limits of agreement (d +/- 2 s) were -1.6/1000 and 3.6/1000. CONCLUSION: The comparison of DOB and cPDR values by NDIRS and IRMS shows a moderate to good linear correlation. However, the distance of the limits of agreement is rather wide. Consequently, the validity of the MTB is diminished, which makes MTB by NDIRS less suitable for exact evaluation of non-invasive assessment of duodenal pancreatic lipase activity. Further studies are necessary to determine sensitivity and specificity of the MTB with NDIRS in larger study populations.

Esophageal motility patterns in patients with and without coronary heart disease and healthy controls.

BACKGROUND/AIMS: The aim of the study was to evaluate esophageal motility patterns in patients with chest pain with and without coronary artery disease, in order to elucidate the question: Does "non-cardiac" chest pain really exist? METHODOLOGY: Patients with chest pain and normal coronary angiograms, patients with chest pain and coronarographically diagnosed coronary artery disease and controls were prospectively studied with long-term manometry. RESULTS: The pressure amplitudes were 38.3 (NCA)/39.82(CAD) and 30 (CG) mmHg (p<0.02, p<0.02) distally and 30/28.1 and 25.5 mmHg (p<0.02) proximally. The percentage of propulsive contractions were 51.5%/45% and 53.5% (p<0.05) and of simultaneous contractions were 18.5%/23% and 10% (p<0.0005, p<0.0001). CONCLUSIONS: Esophageal motility patterns of patients with chest pain and normal coronary angiograms and coronary artery disease differ significantly from controls. Both patient groups show a considerable overlap in motility disturbances. These data indicate that the term "non-cardiac" chest pain in fact does not sufficiently characterize patients' status.

[13C-mixed triglyceride CO2 exhalation test. Investigation with an isotope selective, non dispersive infrared spectrophotometer of indirect function of the exocrine pancreas]. / 13C-mixed-Triglycerid CO2-Exhalationstest. Untersuchung mit einem isotopenselektiven, nicht dispersiven infrarotspektrometer zur indirekten Beurteilung der exokrinen Pankreasfunktion.

BACKGROUND AND OBJECTIVE: The 13C-mixed-triglyceride CO2-exhalation test (MTE) has been proposed for the noninvasive assessment of intraluminal duodenal pancreatic lipase activity. Up to now, stable isotope analysis of carbon dioxide of the MTE has been carried out with isotope ratio mass-spectrometry. The aim of the present study was to evaluate the MTE in patients with morphological signs of chronic pancreatitis (stages I-III) and exocrine pancreatic insufficiency by using an isotope-selective nondispersive infrared spectrometer (NDIRS). PATIENTS AND METHODS: 20 healthy volunteers (9 females, 11 males, age range 19-61 years) and 16 patients (7 females, 9 males, age range 33-76 years) were examined. After an overnight fast each patient received a solid-liquid test meal containing 250 mg 1,3 distearyl, 2[13C] octanoyl glycerol. Breath samples were obtained at baseline and at 30 min intervals over a period of 6 h after the test meal. The 13C/12C isotope ratio in each breath sample was determined by NDIRS as delta (%) and delta over baseline (%). Results were expressed as cumulative percentage dose of 13C recovered (cPDR) at 3, 4, 5, 6 h and maximal PDR (PDRpeak) (median; 5./95. percentile). RESULTS: Significant lower values concerning cPDR 3, 4, 5, 6 hours and PDRpeak [%] were found between healthy subjects and patients with chronic pancreatitis (p < 0.05): cPDR 6 h: 8.1 (0.4-20.5)% vs 29.1 (10.3-59.3)%; PDRpeak: 4.7 (0.4-10.2)% vs 9.2 (5.4-14.3)%. INTERPRETATION: In general, the MTE discriminates between healthy controls and patients with chronic pancreatitis and exocrine pancreatic insufficiency. However, the MTE using NDIRS cannot be recommended as a method of clinical routine because of marked data overlap between pathologic and normal values.

[Vertebral destruction with sever pain in the SAPHO syndrome]. / Wirbelkörperdestruktionen mit massiven Schmerzen durch das SAPHO-Syndrom.

HISTORY AND ADMISSION FINDINGS: A 57-year-old man had for the past 18 months complained of recurrent, recently worsening, belt-like backache radiating ventrally. On admission a skin rash consisting of blister and pustules was noted on the palms of both hands. He had pain on pressure over the right upper abdomen, an enlarged prostate and definite pain on percussing the vertebral column with restricted movement of the thoracic vertebral column, but no other physical signs. INVESTIGATIONS: Radiology revealed clearly increased sclerosis of several thoracic vertebrae with osteolytic destruction and a paravertebral soft tissue tumor. Search for a primary tumor was unsuccessful. Bone scintigraphy demonstrated nuclide enrichment of the thoracic vertebrae and of the sternoclavicular joints without increase in the LeukoScan. These findings indicated the diagnosis of SAPHO syndrome (synovitis-acne-pustulosis-hyperostosis-osteomyelitis). TREATMENT AND COURSE: Rapid subjective and objective improvement followed the administration of clindamycin and ibuprofen. CONCLUSION: In case of bone pain of uncertain aetiology, especially when associated with skin rash, the rare SAPHO syndrome should be considered in the differential diagnosis, avoiding lengthy diagnostic steps and allowing early treatment.

13C-methacetin breath test: isotope-selective nondispersive infrared spectrometry in comparison to isotope ratio mass spectrometry in volunteers and patients with liver cirrhosis.

The 13C-methacetin breath test (MBT) has been proposed for the noninvasive evaluation of the hepatic mixed function oxidase activity. Up to now, stable isotope analysis of carbon dioxide of the MBT has been carried out with isotope ratio mass spectrometry (IRMS). The aim of the present study was to test a recently developed isotope-selective nondispersive infrared spectrometer (NDIRS) in comparison to IRMS in healthy volunteers and patients with liver cirrhosis. Ten healthy volunteers (range 22 to 76 years) and ten patients with histologically proven liver cirrhosis (range 47 to 71 years; Child Pugh score A = 5, B = 3, C = 2) were studied. After an overnight fast each subject received 2 mg/kg BW of 13C-methacetin dissolved in 100 ml of tea. Breath samples were obtained before substrate administration and after 5, 10, 15, 20, 30, 40, 50, 60, 80, 100, 120, 150, 180 min. The 13C/12C-ratio was analyzed in each breath sample both by NDIRS (IRIS, Wagner Analysen Technik, Worpswede, Germany) and CF-IRMS (ABCA, Europa Scientific, Crewe, UK). Results were expressed as delta over baseline (DOB [/1000]) and as cumulative percentage doses of 13C recovered (cPDR [%]) at each time interval. Correlations between IRMS and NDIRS were tested by linear regression correlation. For measuring agreement an Altman-Bland-plot was performed. Applying correlation analysis a linear correlation was found (DOB: y = 1.068 +/- 0.0012.x + 2.088 +/- 0.2126, r = 0.98, p < 0.0001; cPDR: y = 1.148 +/- 0.0109.x + 0.569 +/- 0.172; r = 0.99, p < 0.0001). For DOB the mean difference (d) was 2.9/1000 and the standard deviation (SD) of the difference was 2.7/1000. The limits of agreement (d +/- SD) were -2.5/1000 and 8.3/1000. The comparison of DOB- and cPDR-values by NDIRS and IRMS shows a high linear correlation. However, the distance of the limits of agreement is wide. Consequently, the validity of the MBT could be influenced which could make MBT by NDIRS unprecise for exact evaluation of hepatocellular dysfunction. Further studies are necessary to determine sensitivity and specifity of the MBT with NDIRS in larger study populations.

[Endosonography controlled transgastric drainage of pancreatic pseudocysts]. / Endosonographisch geführte transgastrale Drainage von Pankreaspseudozysten.

BACKGROUND AND OBJECTIVE: Endoscopic drainage of a pancreatic pseudocyst is an alternative to surgical intervention. But transmural drainage carries the risk of bleeding or perforation. Effectiveness and complication rate of endoscopic ultrasound-guided drainage, to avoid these risks, was investigated. PATIENTS AND METHODS: Eleven patients (eight men, three women; mean age 55 years) with a pancreatic pseudocyst (nine with alcoholic and two with biliary pancreatitis) were studied prospectively between 1996 and 1998. In all of them transpapillary drainage of the cyst had not been technically possible. After an endoscopic ultrasound (EUS) examination, the gastric wall was incised with a fistulotome under EUS guidance. A guide-wire was then advanced through the fistulotome into the pseudocyst. A double pigtail catheter was implanted for drainage. The size of the pseudocyst was monitored sonographically at two-week intervals. RESULTS: A cystogastrostomy was successfully established in ten of the twelve patients without serious complication. The pseudocyst was no longer demonstrated after a mean of 4.2 months (2 weeks to 6 months), while a small pseudocyst (1.6 cm [0.9-2.4 cm) remained in three patients. In two of the latter the size of the pseudocyst increased again after removal of the drainage catheter. Complete drainage by repeat cystogastrostomy succeeded in one of them, while a cystojejunostomy was established in the other. CONCLUSION: Endoscopic ultrasound-guided transgastric drainage of a pancreatic pseudocyst is an effective treatment with few complications.

[The 13C-methacetin breath test for quantitative noninvasive liver function analysis with an isotope-specific nondispersive infrared spectrometer in liver cirrhosis]. / 13C-Methacetin-Atemtest zur quantitativen nicht-invasiven Leberfunktionsanalyse mittels eines isotopenselektiven nicht-dispersiven Infrarotspektrometers bei Leberzirrhose.

BACKGROUND AND OBJECTIVE: Cytochrome-P450-dependent liver function can be measured with the 13C-methacetin breath test (MBT). This has heretofore been done with the use of a mass-spectrometer. This study was undertaken to evaluate the MBT (NDIRS) done with the isotope-selective nondispersive infrared spectrometer. PATIENTS AND METHODS: 20 healthy volunteers (ten women, ten men, aged 22-76 years) and 16 patients (ten women, six men, aged 48-71 years) with histologically confirmed liver cirrhosis (Child-Pugh stage A [n = 7], B [n = 5] or C [n = 4]) were given 13C-methacetin in 100 ml of tea after a 12-hour fasting period. Breath tests were performed before the test drink and 5, 10, 15, 20, 30, 40, 50, 60, 80, 100, 120, 150 and 180 min thereafter. The ratio of 13C to 12C was determined, as delta (/1000), and from it the maximal percentage rate (PDRmax) calculated, as well as the cumulative rate (cPDRmax) after 30, 60, 120 and 180 min (Median and 5th and 95th percentiles). RESULTS: For patients with liver cirrhosis there were significantly lower values for cPDRmax and cPDR after 30, 60, 120 and 180 min than in the healthy subjects (P < 0.002): PDR [%]/h: 3.9 (0.7-15.9) vs. 36.5 (23.1-50.0); cDPR 30 min [%]: 1.1 (-0.2-6.0) vs. 12.4 (7.6-17.1); cDPR 3 h [%]: 9.8 (-2.3-27.5) vs. 36.0 (29.9-45.1). There were significant differences among the patients, depending on their Child-Pugh staging. CONCLUSION: The MBT with the cost-effective NDIRS can reliably and noninvasively distinguish between healthy subjects and patients with liver cirrhosis. The test is therefore suitable for the quantitative analysis of liver functions.

Gastric emptying and antral myoelectrical activity in chronic alcoholics with dyspepsia.

BACKGROUND/AIMS: Chronic alcoholism is known to effect gastric motor activity. An association between gastric motility disorders and abnormal myoelectrical activity has been observed in various gastrointestinal and extra-intestinal diseases. The aim of this study was to investigate the effect of chronic alcoholism on gastric emptying and antral myoelectrical activity. METHODOLOGY: Electrogastrography (EGG) was performed on 20 chronic alcoholics with chronic dyspepsia using a pair of electrodes sonographically placed on the skin overlying the gastric antrum. After an overnight fast, patients were tested over a period of one hour in the a) fasting and b) fed state, after ingestion of a 370 kcal liquid-solid test meal. The following EGG parameters were determined: dominant frequency (DF (cpm); DF (%) in the normal range (2-4 cpm); bradygastria (<2 cpm); tachygastria (4-10 cpm); dominant frequency instability coefficient (DFIC), and postprandial to fasting power ratio (PR). The data were correlated with results obtained from 20 controls matched for age and sex. In 18 alcoholics, the EGG data were compared to the percentage of radionuclides (liquid phase labeled with 99m Tc colloid) remaining in the stomach after 60 minutes (%) (gamma camera system). Moreover, for the alcoholics, various parameters such as ethanol consumption, and gastrointestinal symptoms were determined and related to EGG values and scintigraphy. RESULTS: About 50% of the alcoholics showed delayed gastric emptying compared to normal values previously reported (t 60 values: >68%). In opposite to scintigraphy, the alcoholics did not exhibit abnormalities in antral myoelectrical activity. They had significantly decreased bradygastria measures compared to controls (p<0.05). The scintigraphic t 60 values did not correlate either with EGG values or with dyspepsia and clinical parameters. EGG values did not correlate with dyspepsia. However, increased preprandial DF was significantly correlated with ethanol consumption. CONCLUSIONS: Chronic alcoholism induces a disturbance of gastric emptying, probably resulting from toxic damage of the gastrointestinal smooth muscles. Disturbances in antral myoelectrical activity were not found.

Cure of H. pylori infection using a 7-day triple therapy combining pantoprazole with two antibiotics.

BACKGROUND: Acid pump inhibitors combined with antimicrobials cure gastritis and peptic ulcer disease but a standard therapy has not yet been established. We therefore investigated a triple therapy with pantoprazole. METHODS: The aim of this open-label monocenter trial, involving 30 intention-to-treat patients with peptic ulcer disease or functional dyspepsia, was to assess the H. pylori cure rate after a 7-day triple therapy with pantoprazole (40 mg bid) plus metronidazole (500 mg bid) and amoxicillin (1 g bid). The H. pylori status was assessed by rapid urease test, histological examination and culture at the initial examination and by histological examination and culture at the study end 4 weeks after ending all therapy. RESULTS: At the end of the trial H. pylori was eradicated in 21 of 27 per protocol patients (78%; 95% CI 58-91%) and in 21 of 30 patients included in the trial (70%; 95% CI 51-85%). In 15 of 16 per protocol patients with metronidazole-sensitive strain (94%; 95% CI 70-100%) the infection was cured, but in contrast eradication was accomplished in only one of 3 patients with a metronidazole-resistant H. pylori strain. Post-treatment resistance to metronidazole was observed in 6 cases, although 4 of them had had H. pylori strains sensitive to metronidazole at the initial visit. The gastritis had clearly been improved, and the activity of gastritis had completely disappeared 4 weeks after treatment. Seven adverse events were observed in 7 patients, the intensity of which was moderate in 6 cases. CONCLUSIONS: This short-term triple therapy with pantoprazole, amoxicillin and metronidazole provides an effective regimen especially in patients with metronidazole-sensitive strain.

[The value of electrogastrography for the diagnosis of gastroenterologic function]. / Stellenwert der Elektrogastrographie in der gastroenterologischen Funktionsdiagnostik.

BACKGROUND AND OBJECTIVE: Abnormalities of gastric myoelectric activity can be measured by electrogastrography (EGG). Such dysfunctions can be associated with disorders of gastric motility. It was the aim of this study to investigate the relationship between gastric electrical activity and motility in patients with dyspepsia due to gastrointestinal or extraintestinal disease. PATIENTS AND METHODS: 135 consecutive patients with dyspepsia (standardized score) were enrolled in this prospective study including patients with functional dyspepsia (FD) (n = 25), dyspepsia in diabetes mellitus type II (n = 27), hyperthyroidism (n = 23), progressive systemic scleroderma (PSS) (n = 20), chronic alcoholism (n = 20), and 20 patients with gastric lesions: gastric ulcer (n = 10) or gastric cancer (n = 10). The EGG measurements were performed over 60 min pre- and post-prandially state after ingestion of a solid-liquid test meal (370 kcal). The following parameters were measured: dominant electrical frequency (DF), percentage of DF in the normal frequency range (2-4 cpm), bradygastria (< 2 cpm), tachygastria (4-10 cpm), dominant frequency instability coefficient (DFIC), and power ratio. The data were compared with results in 40 healthy persons. The gastric emptying was determined by the gastric retention of 99mTc colloid after 60 min (gamma camera). RESULTS: Nearly 50% of FD patients had delayed gastric emptying (gastric retention after 60 min > 68%): they patients exhibited significantly more tachygastrias than those with normal gastric emptying (P < 0.05). Patients with diabetes mellitus type II, PSS and chronic alcoholism showed normal electrical activity, although gastric emptying was delayed in nearly 50%. The hyperthyroid patients had increased tachygastria without abnormal gastric motility. Gastric lesions did not produce pathological electrogastrograms. The dyspepsia score did not correlate with either EGG or radioscintigraphy in the various patient groups. CONCLUSIONS: Electrogastrography can detect tachygastrias, which are significantly increased in some patients with functional dyspepsia. Because of therapeutic consequences electrogastrography seems to be indicated in patients with functional dyspepsia.

[Increased occurrence of esophageal hypermotility disorders in patients with arterial hypertension]. / Gehäuftes Auftreten hypermotiler Funktionsstörungen des Osophagus bei Patienten mit arterieller Hypertonie.

BACKGROUND AND OBJECTIVE: It has been noted in previous manometric examinations of the oesophagus in patients with chest pain that abnormal motility was often associated with arterial hypertension. A systematic study of this relationship was therefore undertaken. PATIENTS AND METHODS: In 40 patients with chest pain (18 women and 22 men, mean age 54.7 [24-70] years) and in 20 healthy volunteers (12 men, 8 women, mean age 50.8 [22-63] years) standardized oesophageal manometry and arterial blood pressure monitoring were performed over 24 hours. Coronary heart disease and gastrointestinal lesions had been excluded by angiography and endoscopy, respectively. RESULTS: 20 patients (group H) had hypertension (median 24-hour blood pressure > 135/85 mmHg), while 20 patients (group N) and the normal controls (group K) were normotensive. Oesophageal manometry data differed significantly between the three groups regarding distal pressure amplitude (in hPa [hectopascals]; group H: 62 hPa*,**, group N 44 hPa* and group K 36 hPa**; [*P < 0.0005]) and the proportion of simultaneous contractions (group H 23%, group N 22%**, group K 10%***; ***P < 0.001). The hypertensive patients had significantly more frequent motility abnormalities than normal controls (13/20 vs 4/20, P < 0.001); while normotensive patients had more frequent episodes of abnormal propulsion in the oesophagus (proportion of propulsive contractions in group H: 53%, in N: 44%, in K: 59%; P < 0.01). CONCLUSION: Oesophageal motility differed significantly in patients with chest pain from that in healthy controls. Patients with chest pain and hypertension more frequently had oesophageal hypermotility. This suggests a generalized abnormality of smooth muscle.

Primary and acquired Helicobacter pylori resistance to clarithromycin, metronidazole, and amoxicillin--influence on treatment outcome.

OBJECTIVE: The aim of this study was to evaluate the primary and acquired resistance of H. pylori against clarithromycin, metronidazole, and amoxicillin, and to elucidate the consequential influence on H. pylori eradication. METHODS: A total of 195 patients with positive H. pylori status were consecutively included. In 172 patients, H. pylori could be cultured for evaluation of primary antibiotic resistance. Fifty patients received a 2-wk dual therapy with an acid inhibitor and amoxicillin 2,000 mg daily (A), the other 122 patients a 1-wk modified triple therapy with the acid inhibitor clarithromycin 500-1,000 mg daily, and metronidazole 1,000-1,500 mg daily (B: n = 78), or amoxicillin 2,000 mg daily and metronidazole 1,000 mg daily (C: n = 44), respectively. Acid inhibition was conducted with pantoprazole 40 mg b.i.d. (n = 62), omeprazole 20 mg b.i.d. (n = 50), lansoprazole 30 mg b.i.d. (n = 10), or ranitidine 150 mg t.i.d. (n = 50). After therapy, 36 patients remained H. pylori-positive, 20 after dual therapy (A) and 16 after modified triple therapy (B: n = 7, C: n = 9). In 32 of these patients, H. pylori could be recultured for evaluation of acquired resistance (A: n = 18, B: n = 7, C: n = 7). RESULTS: Primary H. pylori resistance to metronidazole was observed in 36 of 172 patients (21%) and to clarithromycin in three of 172 (2%). Acquired resistance was found in six of 14 (43%) and in two of seven (29%), respectively, whereas neither primary nor acquired H. pylori resistance to amoxicillin was noted. Patients infected with metronidazole resistant H. pylori strains were successfully treated in combination with clarithromycin (eight of nine vs 63 of 67 with sensitive strains, NS), but not with amoxicillin (one of eight vs 32 of 34 with sensitive strains, p < 0.0001). In two patients with acquired combined clarithromycin and metronidazole resistance, modified triple therapy failed. CONCLUSION: The value of modified triple therapy with amoxicillin and metronidazole is significantly limited by metronidazole resistance. However, metronidazole resistance does not negatively influence treatment outcome in modified triple therapy including clarithromycin. H. pylori resistance to amoxicillin still is not present.

Oesophageal motility patterns and arterial blood pressure in patients with chest pain and normal coronary angiogram.

BACKGROUND AND OBJECTIVES: In previous manometric investigations, we observed that patients with chest pain and arterial hypertension frequently tend to display oesophageal motility abnormalities. Therefore, we set out to study this systematically. METHODS: Patients with chest pain and normal coronary angiogram (n=40) and healthy controls (n=20) were studied prospectively in a standardized fashion using a portable oesophageal manometry and blood pressure registration system over 24 hours. RESULTS: Twenty patients exhibited increased arterial blood pressure (24 h median > 135/85 mmHg), while in the other 20 patients and all controls the 24 h blood pressure patterns were normal. Median pressure amplitudes in the distal oesophagus were 46.5, 33 and 27 mmHg in patients with or without arterial hypertension and controls, respectively, and 30, 27 and 27 mmHg in the proximal oesophagus, respectively. The durations of distal contractions were 3.9, 3.4 and 3.4 s, respectively, and those of proximal contractions were 3.2, 3.0 and 3.2 s, respectively. Percentages of propulsive contractions were 53%, 44% and 59%, respectively, and those of simultaneous contractions were 23%, 25% and 10%, respectively. CONCLUSIONS: Patients and controls differ significantly regarding their oesophageal motility patterns. Patients without arterial hypertension exhibit impaired propulsion of oesophageal contractions, whereas patients with arterial hypertension tend to produce oesophageal hypermotility. This suggests that, depending on the presence or absence of arterial hypertension, different pathomechanisms of oesophageal motility disturbances come into play.