Antral mucosa heterotopy in the duodenal bulb.

A case of heterotopic antral mucosa presenting as a typical gastric fold, located in the duodenal bulb, is described. Heterotopic gastric mucosa consisting mainly of fundic-type epithelium is commonly found in the gastrointestinal tract and predominantly in the cervical esophagus and the duodenal bulb. Heterotopic gastric mucosa composed of antral-type epithelium, especially of the size described here, is an extremely rare condition. A knowledge of these lesions is clinically relevant in the differential diagnosis at endoscopy of the upper tract.

Treatment of relapsing bleeding peptic ulcers with the somatostatin analogue SMS 201 995 in a patient with Zollinger-Ellison syndrome.

SMS 201-995 is an octapeptide analogue of natural somatostatin characterized by pharmacological properties similar to those of somatostatin itself. In addition, its serum half-life of about 60 minutes after i.v. injection is significantly longer than that of the natural compound. A patient with active bleeding from a peptic ulcer jejuni due to a Zollinger-Ellison syndrome was successfully treated with SMS 201-995. Bleeding stopped after continuous infusion (25 micrograms/h) within the first 24 hours of infusion. The serum gastrin concentration dropped from 3,300 pg/ml to 170 pg/ ml (normal range 40-100 pg/ml). Continuation of the treatment by subcutaneous injections of SMS 201-995 (100 micrograms twice daily) maintained serum gastrin concentrations between 300 to 400 pg/ml over a period of 8 months. Side effects have not been observed. Four subsequent endoscopic examinations have revealed no ulcer relapse.

New unusual forms of colitis. Report of four cases with known and unknown etiology.

Four patients with colitis, in two of whom the etiology was unknown, are presented. One patient with discontinuous segmental colitis was infected by Aeromonas hydrophila, and another with presumed idiopathic inflammatory bowel disease was superinfected by this pathogen. Although Aeromonas hydrophila has been known as a rare cause of diarrhea in our region, it is in the first instance reported to cause severe long-lasting colitis as well as superinfection of idiopathic inflammatory bowel disease (IIBD). Another patient presented with segmental ischemic colitis which was rather atypical and of unknown etiology; the patient was young and had no predisposing factors for vascular occlusive disease. The fourth patient with long-lasting segmental granulomatous colitis which was suspected to be parasitic in origin remained without a definitive diagnosis. This presentation of patients with endoscopically proven colitis should in view of our increasing knowledge of colitis remind us to keep a look out for new infections and other forms of inflammatory bowel disease.

Percutaneous decompression of an intraintestinal balloon--case report.

A study was designed in order to determine whether waterfilled intragastric balloons are superior to airfilled balloons for facilitating weight reduction. In the first volunteer the small intestine was obstructed by the dislocated waterfilled balloon. This complication was successfully treated by transabdominal fine needle puncture of the balloon. In contrast to airfilled balloons waterfilled balloons offer two advantages: water does not escape through the very thin wall of the balloon; the intraabdominal location of a waterfilled balloon is easily checked by sonography.

[Colonorectal adenoma: relationships among histological structure, dimensions of the polyps, and age distribution]. / Gli adenomi colorettali. Relazioni tra struttura istologica, dimensioni dei polipi e distribuzione tra le età.

Among 1258 polyps from the lower gastro-intestinal tract removed by rectoscopy or coloscopy and examined histologically there were 744 adenomas, 72% tubular, 27% papillary and 1% villous. 96.5% of all adenomas were extracted from patients aged over 40 years. Four fifths of the tumours were found in the rectum and sigmoid colon. Only 6% of the tubular adenomas were more than 15 mm in diameter, compared with 32% of papillary and 57% of villous adenomas. The special significance of the adenomas lies in their potential malignancy (adenoma-to-cancer sequence).

The role of antibiotics in Campylobacter pylori associated peptic ulcer disease.

Since the recognition and first culture of Campylobacter pylori (Cp) the hypothesis of a pathogenic role has been strengthened by numerous investigations. Its close association with active chronic gastritis and even active duodenitis, and the disappearance of these pathologic conditions with antimicrobial treatment suggest a pathogenic role for Cp in active chronic gastritis. The close association of antral gastritis with duodenal ulcer (DU) suggests that Cp associated active chronic gastritis may be an important precondition for the development of DU. Therapy studies so far using either bismuth, antibiotics, or a combination of both could demonstrate that the healing of DU ulcer was closely related to the clearance of Cp and healing of gastritis. Relapse of DU was closely associated with reappearance of Cp and active chronic gastritis. At the present state the combination of bismuth salts and antibiotics has achieved the highest eradication rates of Cp and thus lowest relapse rates of DU. Antibiotics therefore seem to be an indispensable factor in the antimicrobial treatment of Cp associated diseases.

Stimulation of gastric acid secretion by intravenous amino acid infusion and its inhibition by H2-receptor antagonists ranitidine and cimetidine.

It is known that intravenous amino acid infusions stimulate gastric acid secretion. In 20 healthy volunteers we studied the effect of amino acid infusion on gastric acid secretion and inhibition of the latter by the H2-receptor antagonists ranitidine and cimetidine. Acid output was measured by modified intragastric titration. Initial stimulation of acid secretion until plateau levels was achieved by pentagastrin infusion 2 micrograms kg-1 h-1. After 30 min a standard amino acid infusion at 2.1 ml kg-1 h-1 was started, together with a bolus injection of either cimetidine 200 mg in group 1 (n = 10), or ranitidine 50 mg in group 2 (n = 10). Normal saline served as a control in both groups on a second occasion. The amino acid infusion was continued for 60 min and gastric acid output redetermined until constant. Amino acid infusion increased gastric acid secretion by 67% above submaximal pentagastrin-stimulated level in group 1 and by 47% in group 2. With concurrent administration of an H2-receptor antagonist in the presence of amino acid infusion, gastric acid secretion was inhibited by 41.4% (P less than 0.004) by cimetidine and by 52.9% (P less than 0.001) by ranitidine below initial pentagastrin-stimulated levels. In order to avoid the increased acid output produced by amino acid infusions, it therefore may be desirable to administer an H2-receptor antagonist concurrently.