The role of enteroclysis in the diagnosis of unexplained gastrointestinal symptoms: a prospective assessment.

The purpose of this prospective study performed at a non-university hospital was to assess the role of enteroclysis in the diagnosis of unexplained gastrointestinal symptoms such as abdominal pain, gastrointestinal bleeding, and chronic diarrhea done following inconclusive imaging or endoscopic procedures. 184 consecutive patients were subjected to enteroclysis over 25 months. 84 (46%) had abdominal pain, 52 (28%) gastrointestinal bleeding, and 48 (26%) chronic diarrhea. Findings were categorized as normal and abnormal (subdivided into main, i.e., explanatory of symptoms; and secondary, i.e., not explanatory of symptoms). Main findings were further divided into those exclusively detected by enteroclysis and those confirmed by this procedure. Normal enteroclysis investigations were obtained in 159 (86%) patients and abnormal in 25 (14%). Main findings were present in 19 (10%) patients, in ten (5%) of them exclusively detected by enteroclysis. Secondary findings were present in six (3%) patients, also detected only by enteroclysis. The highest rate of main findings exclusively detected by enteroclysis related to patients with chronic diarrhea (8%), compared with 6% and 2% with abdominal pain and gastrointestinal bleeding, respectively. For the inspection of the small bowel, enteroclysis shall remain the gold standard for detecting abnormal findings in the small bowel until user-friendly enteroscopes are developed.

Xanthine oxidase inhibitor in acute experimental pancreatitis in rats and mice.

It has been suggested that oxygen-derived free radicals play a decisive role in the pathogenesis of acute experimental pancreatitis in a model of edematous pancreatitis. Accordingly, allopurinol, a xanthine oxidase inhibitor, was shown to mitigate the development of nonfatal acute pancreatitis in ex vivo perfusion models using dogs. For further evaluation of allopurinol, its effect was studied in two forms of fatal necrotizing acute experimental pancreatitis: sodium taurocholate-induced pancreatitis in rats and choline-deficient ethionine-supplemented diet-induced pancreatitis in mice. Allopurinol did not affect the mortality rate, pancreatic enzyme elevation in serum and ascites, the enzyme content of the pancreas, or any parameter indicating histopathological damage in the pancreas. Although these experiments did not determine the role oxygen-derived free radicals play in the development of pancreatitis, they show, none the less, the absence of any beneficial therapeutic effect of a xanthine oxidase like allopurinol on the development of the disease once it has begun.

Effect of FOY-305 (camostate) on severe acute pancreatitis in two experimental animal models.

Two models of severe acute pancreatitis were chosen and pancreatitis induced by sodium taurocholate and by a choline-deficient ethionine-supplemented diet, to evaluate the effectiveness of FOY-305 (camostate), a new synthetic trypsin inhibitor. Prophylactic administration of FOY-305 had a significantly favorable effect on the course of the sodium taurocholate-induced disease and on the survival rate of the treated group. A beneficial effect on the amylase and lipase content in serum and ascites was found, but no effect was observed on enzyme concentration in pancreatic tissue or on the degree of histologically detectable organ destruction. Therapeutic administration of FOY-305 had a significantly positive influence when infused directly, 5 and 30 min after the operation, whereas enzyme increase and organ destruction remained unaffected. FOY-305 showed a beneficial effect when given prophylactically or therapeutically at the beginning of the pancreatitis induced by a CDE diet, with no significant change in enzyme increase and degree of organ destruction. The favorable effect on survival time and rate in the early phase of these two severe experimental forms of pancreatitis may justify an evaluation of FOY-305 in a clinically controlled study.

Small intestinal function in chronic relapsing pancreatitis.

In a prospective study, several parameters of small intestinal function have been assessed in 20 patients with chronic relapsing pancreatitis with and without steatorrhoea. By and large all routine parameters of small intestinal function were found to be normal. In particular, neither a previously reported high incidence of lactase deficiency, nor D-xylose malabsorption or vitamin B12 depletion was observed. However, there was a high incidence of abnormal 14C-cholylglycine breath tests (40%), suggesting the presence of mild bacterial overgrowth. Occasionally, this condition was associated with diarrhoea and steatorrhoea, thus indicating that steatorrhoea remaining after high-dosage pancreatin supplementation might sometimes be due to bacterial overgrowth.

[Colonic stenosis after pancreatitis]. / Kolonstenosen nach Pankreatitis

In 5 out of 35 patients with acute, acute relapsing and chronic pancreatitis, barium enema revealed partial colonic stenosis at the splenic flexure. In 3 patients laparotomy disclosed colonic perforation with abscess, adhesions between colon and pancreas or a marked pancreatic edema. In two patients barium enema follow-up 3-6 months later showed spontaneous resolution of the stenosis. Comparison with 35 cases in the literature shows that colonic stenosis after pancreatitis is usually incomplete, located at the splenic flexure and due to adhesions between the colon and the pancreas. Spasmodic pains in the upper abdomen, increasing constipation and often rectal bleeding or positive guaiac test of the stool may indicate colonic stenosis. Spontaneous resolution is possible, but if operation is indicated the adhesions should be carefully dissected in order to obviate resections of the colon or the pancreas.