Epidemiology and etiology of "autonomous" nonspecific duodenitis.

In this prospective study we looked for possible epidemiological and etiological factors in "autonomous" nonspecific duodenitis. Of 136 dyspeptic patients who entered the study, duodenitis was found in 25.6% (94.4% chronic duodenitis and 5.6% isolated active duodenitis). Men predominated with a significant prevalence of 74%; 49% of them had white-collar jobs, but age, psychological factors, and the season of the year played no role. We found that smoking and alcohol and coffee intake bore no relation to duodenitis. Helicobacter pylori (HP) was present in only 17.1% of patients with duodenitis, little different from the 10% prevalence in dyspeptic patients without duodenitis. HP was always associated with gastric metaplasia and inflammatory activity.

[Esophageal angina]. / Angina esofagea.

Angina-like chest pain, caused by alterations of esophageal function, is an increasingly common occurrence confronting cardiologists: advances in pathogenetic knowledge and in diagnostic possibilities in this field have in fact shed light on the prevalence of esophageal angina, which is present in approximately 60% of patients with angiographically intact coronaries (11% of anginal patients overall). Classically, esophageal chest pain is attributed to alterations of motility or to mucosal disease (pathologic gastro-esophageal reflux of the acid, mixed or alkaline type): this last cause prevails quantitatively. Little is known of the nociceptive mechanisms triggered by these alterations: as far as mucous disease is concerned, activation of the chemosensitive receptors has been postulated, while esophageal mechanoreceptors may be activated, in the course of a motor disorder, by distension of the wall. A recently proposed additional mechanism consists in the induction of parietal esophageal ischemia by chemical or mechanical injury: it is a fascinating and potentially resolvable mechanism, which however requires further investigation. Moreover, elements of psychological nature are also involved in the genesis of esophageal pain. A diagnosis of esophageal angina, heavily conditioned by obvious considerations of prognostic order, must necessarily aim for "certainty". Prolonged monitoring of the endoluminal pH and the adoption of provocative tests, in the course of pH monitoring and manometry, play an important role in achieving this aim (ergometric test, distension induced with a balloon, edrophonium, electrostimulation, seem most effective). A promising outlook is supported by the recent introduction of prolonged manometry. Finally, diagnostic attitude must necessarily abandon its limited specialistic horizon to consider the patient's profile in its entirety.

[Diagnostic evaluation of the patient with esophageal chest pain: our experience]. / Valutazione diagnostica del paziente con dolore toracico esofageo: la nostra esperienza.

Our experience in the field of the "cardio-esophageal" differential diagnosis of angina-like pain derives from the close cooperation between the Divisions of Gastroenterology and Cardiology. Commonly applied tests of esophageal function, always performed during electrocardiographic monitoring, are prolonged gastro-esophageal pH monitoring plus the adoption, as provocative tests, of the stress test in the course pH monitoring, of endo-esophageal distension and of electrostimulation in the course of manometry. An evaluation of prolonged pH monitoring tracings is performed not solely to locate a quantitatively pathological reflux, but especially to identify temporal correlations between the symptoms and the reflux. This explains how we were able to relate pain to reflux in 63% of the patients who took the test. Furthermore, use of esophagogastric monitoring makes it possible to identify the critical share of the non-acid reflux, i.e. mixed (21%) or alkaline (6%). Episodes of non-acid reflux feature a significantly higher rate of association with pain than acid reflux (12.5% of symptomatic acid refluxes, versus 6% of symptomatic acid refluxes, versus 6% of mixed refluxes and 7.15% of alkaline refluxes). Execution of an ergometric test, performed according to routine cardiologic procedures during pH monitoring, constitutes a valid stimulation for reflux-dependent pain, enabling us to achieve a diagnostic gain of 15.5% compared to pH monitoring alone. As stated, elicitation of pain by motor causes is performed using endo-esophageal distension (positive in 30% of cases) and with electrostimulation, a new test studied at our center.(ABSTRACT TRUNCATED AT 250 WORDS)